Compression Fractures of the Spine

The spine has about 24 vertebrae (although some people may have a few more or a few less). Each vertebra [VER-tih-brah] in the spinal column has two main sections. The first part is the spinous [SPY-nuss] process, which is the knobby part that you can feel through your skin on your back. The spinous process rarely breaks.

The other part is the vertebral body, which is shaped like a circle. Each of these circle-shaped vertebral bodies stacks one on top of the other to form the spine. Together, they provide most of the structural support of the spinal column, which contains the spinal cord.

A compression fracture is when one of the small bones in the spine, called vertebrae [VER-tih-bray], collapses or becomes compressed. It is caused by some extreme force or pressure. Usually only the vertebral body part will break because it’s weaker than the spinal process part. Because of this, most compression fractures are wedge-shaped, meaning that only one part of the vertebra collapses while the other remains intact.

Most forces are not strong enough to cause a compression fracture in a normal, healthy spine, so these breaks often happen in spines that are already weak from osteoporosis, arthritis, age, or another condition.

Sometimes the force can be enough to collapse more than one vertebra, which is called multiple compression fracture. This kind of fracture can reduce the support the spine can provide, leading to spinal deformities. It can even change the shape of the spine so much that a person may notice a loss of height.

Single or multiple compression fractures of the spine can be very painful, and can sometimes lead to other problems like spinal stenosis that cause even more pain. Spinal stenosis [steh-NO-sis] is a narrowing of the spinal canal. This narrowing compresses the nerves in the spine, which can be very painful and cause other symptoms.

Signs and symptoms of a single or multiple spinal compression fracture can include:

• Numbness
• Tingling
• Weakness
• Problems going to the bathroom (either the inability to control when you go to the bathroom, or the inability to urinate)

Symptoms can vary a lot from person to person, and you might have other symptoms that aren’t listed here.

Compression fractures can also cause serious pain, most often in your back, hip, abdomen, or thigh. The specific place where you feel pain will depend on which bones are broken.

Your spine has nerves that connect to every other part of the body. When the vertebrae are damaged or the spinal column is narrowed, these nerves can be under pressure, which can cause severe pain in other parts of your body like your hands, legs, or chest.

You should make an appointment to see your doctor if you have back pain and any of the following situations are present:

• You have been diagnosed with cancer.
• Your pain is the same while at rest or during activity.
• Pain is worse while you are sleeping than when you are awake.
• You are older than 65 or younger than 12.
• You have recently experienced unintentional weight loss.

Some symptoms can be a sign of a more serious injury, disease, or condition. Go to the emergency room right away if you have back pain and any of these:

• Severe pain
• Numbness
• Weakness
• High fever (temperature greater than 100.4 degrees Fahrenheit, or 38.0 degrees Celsius)
• Loss of bowel or bladder control

Compression fractures usually happen when the spine is already weak from age or another disease. Risk factors include:

• Osteoporosis [AH-stee-oh-per-OH-sis]. This disease makes bones brittle, which means they can get too weak to support the spine in daily activities. People with osteoporosis can get compression fractures from regular activities like lifting an object, slipping, tripping, sneezing, or even coughing hard.
• Post-menopausal women are more likely to have osteoporosis, so compression fractures are more likely to happen in older women.
• In some cases, although less frequent, weakened bones in the spine are a result of cancer, infection, tumors, or other bone disease. This weakness can also lead to compression fractures.
• Compression fractures can happen in healthy vertebrae during a serious trauma, like falling from a great height or being in a car accident.

Because compression fractures usually happen in cases where you already have weakened bones, your doctor may start by performing tests to determine if you have osteoporosis, infection, or a tumor.

Your doctor will likely take a complete medical history and perform a physical examination to help diagnose a compression fracture, and might order more tests to confirm the diagnosis. Tests can include:

• X-rays, which will produce an image of your bones and help the doctor assess your bone anatomy, but will not show details about soft tissues such as organs, muscles, ligaments, etc.
• MRI, which will produce an image of the organs and other soft tissues of the body.
• CT scan, which uses a combination of an MRI and an x-ray to produce detailed images of any part of the body, including bones, muscles, fat, and organs. CT scans show more details than an x-ray or MRI.
• Nuclear bone scan, which is where a radioactive substance is injected into your body to measure bone activity and helps identify damaged bones. The amount of radiation is small (it is less than the radiation in half of one CT scan).

If you have a compression fracture of the spine, you should work with your doctor to decide on a treatment that will work for you. Your doctor might order treatments that repair the broken vertebra, help the spine heal, or help you with the pain caused by this injury. You may also be given exercises or instructions on self-care that can help make your symptoms better.

Self-care

Some self-care options include:

• The RICE method (rest, ice, compression, elevation)
• Over-the-counter pain medications, such as ibuprofen, naproxen, or other nonsteroidal anti-inflammatory drugs
• Heat treatment to help increase circulation to the damaged area
• Avoiding any strenuous physical activities until your doctor approves them

Self-care can help, but your doctor will probably want to see you regularly to keep track of your progress and make sure your compression fracture is healing properly.

Medical treatment

Generally, doctors try to find treatments for compression fractures that do not require surgery. These treatments may include:

• Activity modifications. Changing the way you do some activities can help reduce the pressure on your spine and help the vertebrae heal faster.
• Back brace. A back brace can hold your spine in place, which can take pressure off of the vertebrae and help them heal.
• Exercise and vitamins. If the fracture was caused by osteoporosis, your doctor will likely also recommend treatment to help prevent more fractures. Some treatments for osteoporosis include weight-bearing exercises and vitamin D supplements.

If you have a serious compression fracture that doesn’t get better with these treatments, your doctor might recommend spinal surgery or spinal fusion.

• Spinal surgery. During this surgery, the surgeon will inject a cement mixture into the fractured vertebrae to help support it. This process also helps reduce the pain and prevent spinal problems from getting worse.
• Spinal fusion. In this procedure, the surgeon will place a bone graft across the damaged, or unstable, area that will allow the vertebrae to grow together (fuse). The surgeon will also place an internal fixation implant, which will further secure the spine and help support it. Screws and rods are used to help hold the vertebrae, as well as the implant, in place while the spine heals.

Pain management

Spinal compression fractures can cause serious back pain, as well as pain in other parts of your spine and throughout your body. When the vertebrae are damaged, they can also cause other painful conditions like spinal stenosis.

Your doctor will work with you to manage your pain, and might refer you to a pain management specialist if your pain is severe. Some options for pain management include:

• Anti-inflammatory medicine. Medicines like ibuprofen and naproxen can reduce swelling and inflammation in your spine, reducing pain.
• Physical therapy.  A physical therapist can teach you special exercises and give you a program to help you regain strength in your spine and reduce your level of pain.
• Opioids. Opioids like oxycodone have risks, but they can help relieve the severe pain caused by spinal fractures.
• Nerve block. Your doctor might inject a special medicine into your spine to block the nerves in that part of your body from sending pain signals to your brain. There are many kinds of nerve blocks for different injuries.

Because compression fractures are commonly linked to osteoporosis, one of the easiest ways to prevent a compression fracture is to prevent osteoporosis. The best time to start preventing osteoporosis is as soon as possible. Some ways you can help prevent osteoporosis are to:

• Exercise regularly to help strengthen your spinal muscles and bones.
• Eat a well-balanced diet.
• Avoid tobacco use because tobacco smoke is shown to weaken bones.
• Take calcium and vitamin D supplements, especially if you are at-risk for developing osteoporosis.
• Talk to your doctor about hormone replacement therapy if you are a post-menopausal woman.
• Talk to your doctor about maintaining bone density and/or reducing the dosage of your medication if you are on steroid therapy for another medical condition.

If you have a weakened spine, try to avoid risk factors for injuring your spine. Your doctor may suggest avoiding certain activities that put extra stress on the spine.