Southwest Scoliosis Institute’s board-certified, fellowship-trained orthopedic doctors Richard Hostin, MD, Shyam Kishan,MD and Kathryn Wiesman, MD, have years of experience treating thousands of patients with complex spine conditions. Because these doctors specialize in the spine and treat patients every day, they possess exceptional knowledge, skills and abilities to ensure that patients get the best treatment and care. Over the years, we have evaluated and helped many, many patients with compression fractures.
Vertebrae, bones that make up the spine, can break like other bones of the body. When the vertebral body collapses, doctors refer to it as a vertebral compression fracture. These fractures occur most commonly in the thoracic spine (the middle portion of the spine), particularly in the lower part. When vertebral fractures occur, the cause can link to a condition such as osteoporosis, a very hard fall, or another type of injury.
Learn about compression fractures including
- What causes compression fractures?
- How to diagnose the condition?
- What treatment options are available?
While awaiting the procedure, our office will obtain authorization to proceed from your Insurance. You may also receive a confirmation letter from them. A stay of one or two days in the hospital may be authorized; if your physician determines that additional days are needed, one of our caseworkers will update your status and extend the authorization. If you are transferring to a rehabilitation center, we will obtain the authorization for the move.
In order to understand your symptoms and treatment choices, you should start with a basic understanding of the anatomy of your mid-back. This includes becoming familiar with the various parts that make up the thoracic spine and how these parts work together.
The vertebral bodies are the round blocks of bone that form the front part of the spinal column. Compression fractures of the spine usually occur at the bottom part of the thoracic spine (T11 and T12) and the first vertebra of the lumbar spine (L1).
Compression fractures of the spine generally occur from too much pressure on the vertebral body. The fracture occurs when the vertebral body collapses, causing the front part of the vertebral body to become wedge-shaped. The bone tissue on the inside of the vertebral body becomes crushed or compressed. This can happen when the spine bends forward at the same time downward pressure builds on the spine. For example, falling to the floor in a sitting position causes the spine to bend and the head to thrust forward. This posture combined with pressure on the buttocks concentrates pressure on the front part of the spine, the vertebral bodies.
There are several causes of compression fractures. If the vertebra becomes too weak to hold normal pressure, it may take very little pressure to cause it to collapse. Most healthy bones can withstand pressure, and the spine absorbs the shock. However, if the forces are too high, one or more vertebrae may fracture.
Osteoporosis can cause compression fractures in the spine because it weakens bones so that they cannot bear normal pressure. Therefore, the spine eventually collapses during normal activity, leading to a spinal compression fracture. Notably, spinal compression fractures are the most common type of fracture from osteoporosis. Forty percent of all women will have at least one fracture by the time they turn 80 years old.
In severe cases of osteoporosis, actions as simple as bending forward can cause a “crush fracture” in a vertebra. Specifically, this type of the vertebral fracture causes loss of body height and a humped back (kyphosis), especially in elderly women.
Compression fractures due to trauma can come from a fall, a forceful jump, a car accident, or any event that stresses the spine past its breaking point. In addition, cancer that spreads to the spine weakens the supportive structure of the spine. Frequently, the bones of the spine become affected by many types of cancers. Thus, cancer may cause the destruction of part of the vertebra, weakening the bone until it collapses.
When a sudden or forceful injury causes a fracture, you will probably feel severe pain in your back, legs, and arms. If the fracture injures the nerves of the spine, you might also feel weakness or numbness. If the bone gradually collapses, such as a fracture from bone thinning, the pain will usually seem milder. Until the bone actually breaks, you will not feel any pain.
In very severe compression fractures, parts of the back of the vertebral body may actually protrude into the spinal canal and put pressure on the spinal cord. Fortunately, this does not normally occur.
Before a doctor can diagnose your condition and design a treatment plan, a complete history and physical exam will take place. There are many possible internal causes of pain. It becomes important to determine and identify the root of the problem.
After your doctor has a better idea of what causes your discomfort, the following testing can identify the exact cause or causes.
- An X-ray of the spine will usually show a broken vertebra.
- If the X-ray shows a fracture, your doctor may also suggest a CT scan to ensure the stability of the broken bone and the nerves are not in danger. The CT Scan can combine with a myelogram if there are any concerns about the spinal cord.
- An MRI might be recommended if your doctor believes injury to the nerves could occur because of the fracture or if questions still exist about the cause of any pain.
- A bone scan might be ordered to help determine the age of a fracture. If the fracture appears old and other healed fractures exist, this observation may indicate osteoporosis. This is important in older patients, particularly women. If osteoporosis appears as a factor, treatment will include preventive measures to try to stop other vertebral fractures from occurring.
- A neurological exam will also take place. This includes testing the nerves by checking your reflexes, muscle strength, and sensory perception. Abnormalities in the neurological examination can point to nerve damage. If damage to the spinal nerves exists, your body movement and neurological responses will occur. Neurological problems are rare- except in younger patients who have experienced a violent injury, such as a car crash.
The most common treatments for a thoracic compression fracture are pain medications, decreasing activity, and bracing. Doctors are also using newer nonsurgical procedures called vertebroplasty and kyphoplasty. These methods are minimally invasive and showing promise in the treatment of vertebral compression fractures. Vertebral fractures usually take about three months to fully heal. X-rays will probably occur on a monthly basis to check on the healing progress. Surgery for compression fractures rarely occurs.
To control pain, doctors prescribe mild pain medicine. Remember that medicine will not help the fracture heal, but it can help control pain.
Learn more about medications used to treat back pain.
You will most likely have to limit your normal activities. Avoid strenuous activity or exercise. Do not lift heavy objects. Stay away from any activity that might place too much strain on your fractured vertebra. If you are elderly, your doctor may put you on bed rest. Older bones take longer to heal than younger bones and are typically thinner and weaker. Treat this fracture as you would any other broken bone-carefully and seriously.
Bracing provides another common form of treatment for some types of vertebral compression fractures. Your doctor may prescribe back support (called an orthosis). The brace supports the back and restricts movement, just as an arm brace would support a fractured arm.
Braces are molded to conform tightly to your body, like a cast for any other fracture. Braces used to treat a compression fracture of the spine are designed to keep you from bending forward. They hold the spine in more extension (straightened). This takes the pressure off the fractured vertebral body and allows it to heal. The brace protects the vertebra and stops further collapse of the bone.
Minimally Invasive Methods
Doctors are using two new procedures to treat compression fractures-vertebroplasty and kyphoplasty. Vertebroplasty is a method of injecting special cement inside the broken vertebral body. It is mainly used to ease pain and improve the strength of the vertebral body.
Kyphoplasty provides the additional benefit of restoring some or all of the normal height of the vertebral body. Doctors slide a tube with a deflated balloon inside the broken bone. The balloon is inflated to help restore the height of the broken vertebra. Bone cement is injected into the cavity formed by the balloon to hold the vertebra at its corrected height.
Spinal surgery is a serious undertaking and is only considered to fix vertebral compression fractures if there is evidence of sudden and serious instability of the spine. For instance, if the fracture leads to a loss of 50 percent of the vertebral body’s height, surgery might prevent the bone from collapsing onto the spinal nerves and causing more serious damage.
If surgery is necessary to remove pressure from the spinal cord, two approaches will be considered, anterior and posterior. Some type of internal fixation may hold the vertebra in the proper position while it heals. Due to the risks and complications associated with it, internal fixation is only done in severe spinal compression fractures. If bone fragments are pushing into the spinal cord and nerves, causing too much pressure, they may need removal.
Like all surgical procedures, operations on the spine may have complications. Because the surgeon operates around the spinal cord and nerves, back operations are always considered extremely delicate and potentially dangerous. You should take the time to review the risks associated with spine surgery with your doctor. Make sure you are comfortable with both the risks and the benefits of the procedure planned for your treatment.
Complications specifically related to a vertebral compression fracture include
- segmental instability
- kyphotic deformity
- neurological complications
If a fracture leads to a vertebral body collapse of more than 50 percent, a risk of segmental instability exists. Each spinal segment is like a well-tuned part of a machine. The parts work together to allow weight-bearing, movement, and support. When one segment deteriorates or collapses to the point of instability, it can produce pain and difficulty doing activities. The instability eventually results in faster degeneration of the spine in this area.
Patients with Kyphosis, a common spine disorder in elderly women, less frequently men, normally possess osteoporosis and frequent fractures. The front of the vertebrae will collapse and “wedge” due to the lack of normal vertebral space. Kyphosis leads to a more rounded thoracic spine. Sometimes this deformity refers to a person with a “round-back posture” or “hunchback”.
Pronounced kyphosis can be a source of severe and debilitating pain. The hunchback deformity may also begin to compress the heart, lungs, and intestines. This in turn leads to fatigue, shortness of breath, and loss of appetite.
If the fracture causes part of the vertebral body to place pressure on the spinal cord, the nerves and spinal cord can be affected. There is some space between the spinal cord and the edges of the spinal canal. This space can be reduced if the pieces of the broken vertebral body push into the spinal canal.
The narrowing of the spinal canal due to a compression fracture can either lead to immediate injury to the nerves of the spine, or it can cause problems later on from irritation of the nerves. If the irritation on the spinal nerves comes later (even after the fracture has healed), it can cause pain and problems if the nerves are not working right. The lack of space can also lower the supply of blood and oxygen to the spinal cord. When the spine needs more blood flow during increased activity, the blood vessels may not be able to swell to get more blood to the spine. This can lead to numbness and pain in the nerves that are affected. The nerves also lose some of their mobility when reducing the space available to them. This leads to irritation and inflammation of the nerves.
If you or a loved one suffers from spinal pain, you owe it to yourself to call Southwest Scoliosis Institute at 214-556-0555 to make an appointment.