What is a Compression Fracture?
A compression fracture is the most common type of fracture to occur in the spine. It most commonly occurs in the lumbar spine (lumbar compression fracture) and thoracic spine (thoracic compression fracture).
In these types of fractures, the height of the vertebral body is decreased at least 15 or 20% from its original height due to fracture of the bone.
Compression Fracture Causes
The most common cause of a spinal compression fracture is osteoporosis, which is a disease where the bone becomes weak and prone to fracture. Oseoporosis is very common in:
- Caucasian and Asian women
- Patients over the age of 60, especially post-menopausal women
- Patients on chronic oral steroids for other medical conditions (oral steroids decrease bone quality)
- Patients who actively smoke as cigarette smoke negatively affects bone quality
Osteoporosis reduces the spine’s ability to tolerate the forces placed on it and predisposes to fracture.
This means that trivial things like bending over, lifting an object, or a fall from a standing height can cause a compression fracture.
Compression fractures can also be caused by less common conditions such as metastatic cancer in the spine, or high energy trauma such as a car accident or a fall from height.
Compression Fracture Symptoms
The symptoms of a compression fracture are new onset back pain. The pain is typically felt in the center of the mid back or lower back but there can be referred pain throughout the back or into the upper buttocks.
This can be caused by a recent fall or even no trauma at all if the bone is especially weak. Nerve pain shooting all the way down the legs is not a component of compression fracture symptoms as compression fractures do not cause spinal canal narrowing.
However, other types of spinal fractures such as burst fractures can cause narrowing of the spinal canal.
If a patient has developed many compression fractures over the years, it can result in kyphosis or a hunched forward posture of the spine causing loss of height and difficulty standing upright.
Compression Fracture Diagnosis
Your doctor will carefully examine you based on the symptoms and medical history. Your doctor may also recommend other diagnostic tests such as:
- X-ray or CT scan : A spinal X-ray or CT scan may be taken to determine the presence of a fracture
- MRI Scan : An MRI of spine may be performed to know if the fracture is old or new and to detect other soft tissue abnormalities
- Bone Scan : A nuclear bone scan may be used to help determine the presence or age of the fracture
- DEXA Scan : Dual Energy X-ray Absorptiometry or DEXA scan, a test to measure bone mineral density, and is typically used to diagnose osteoporosis
The diagnosis of a compression fracture begins with a detailed history and physical exam.
The doctor will ask about the onset of pain, its location, and if the pain is worsening or improving. The doctor will also ask about any previous fractures in the spine or other parts of the body, that may indicate overall poor bone quality.
Standing x-rays will be obtained to look for fractures in the spine.
If previous x-rays have been obtained it is important to bring these to the visit for comparison, as this can provide clues as to whether fractures seen on an x-ray are new or old.
If a DEXA test has previously been performed this will be reviewed to see whether a patient already has a diagnosis of osteoporosis based on their bone density results.
Compression fracture treatment
Non-surgical treatment of compression fractures is typically recommended as these fractures are stable and the vast majority will heal uneventfully in 8-12 weeks.
Sparing use of pain medications and continuing to get some low-impact aerobic exercise in the form of walking is helpful for healing a compression fracture.
A brace can be used but often these are cumbersome and do not provide tremendous pain relief.
Surgical treatments of compression fractures include procedures such as vertebroplasty or kyphoplasty, where cement is injected percutaneously into the fractured vertebral level to stabilize the fracture.
There have been many studies published over the years comparing vertebroplasty and kyphoplasty to non-surgical care and even compared to sham operations, with mixed results.
Currently there is no consensus on whether these procedures have benefit over sham operations or compared to non-surgical treatment.
If a patient still has severe pain with minimal to no improvement after 4-6 weeks of non-surgical treatment, then vertebroplasty or kyphoplasty may be an option to help with pain relief.