COMPRESSION FRACTURES

Why Are Many Vertebral Fractures Not Diagnosed or Treated?

Many vertebral fractures remain undiagnosed and untreated due to a combination of factors.

Common Misdiagnoses

These fractures are often mistaken for more general back issues. For instance, many healthcare providers initially attribute the pain to muscle strains, soft tissue injuries, or even the natural aches associated with aging. This misclassification leads to a significant number of fractures being overlooked.

Lack of Specialized Diagnosis

Diagnostic tools and procedures specifically aimed at detecting vertebral fractures are not always employed. Physicians might depend on less targeted examinations that fail to reveal these specific injuries.

Symptom Overlap

The symptoms of vertebral fractures—such as localized pain—can mimic various other back problems. This overlap makes it challenging to pinpoint the exact cause without in-depth investigations, which may not always be performed in initial consultations.

Statistical Insight

It’s estimated that around two-thirds of vertebral fractures each year go undiagnosed as a result. Without proper diagnosis, effective treatment is not pursued, leading to prolonged suffering and potential complications.

Addressing these diagnostic challenges is crucial for improving patient outcomes and ensuring timely treatment.

Common Misconceptions About Back Pain and Vertebral Fractures

Back pain is a prevalent issue, and it’s often misunderstood, especially when it comes to vertebral fractures. Here are some common misconceptions:

Back Pain Equals Muscle Strain

Many assume that back pain is merely a result of muscle strain or a soft tissue injury. This misunderstanding leads to the misdiagnosis and mistreatment of vertebral fractures.

Age-Related Aches

Another widespread belief is that persistent back pain is just a normal part of aging. While some back pain can be age-related, dismissing it as such without further investigation overlooks the possibility of vertebral fractures.

Lack of Diagnosis

Due to these misconceptions, about two-thirds of vertebral fractures go unnoticed each year. Without proper diagnosis, individuals miss out on necessary treatments that could alleviate their pain and prevent further complications.

It’s crucial to understand that back pain can have various underlying causes, and assuming it’s always something minor can lead to missed opportunities for appropriate care. If you experience persistent or severe back pain, seeking a comprehensive evaluation is essential for accurate diagnosis and effective treatment.

Insurance

While awaiting the procedure, our office will obtain authorization to proceed from your Insurance. You may also receive a confirmation letter from them. Our office will obtain approval for a stay of one or two days in the hospital. 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.

Anatomy

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.

However, the first step in obtaining the best treatment is to get an accurate diagnosis of the compression fracture and its underlying cause. This means consulting with a healthcare professional who can provide a detailed assessment and guide you through the diagnostic process.

Steps to Follow:

• Consult a Specialist: Call and make an appointment at the Southwest Scoliosis and Spine Institute and meet with one of the world’s Finest Spine Doctors.
• Accurate Diagnosis: Ensure that both the compression fracture and its underlying cause are thoroughly evaluated.
• Understand Your Anatomy: Gain a basic understanding of your mid-back anatomy to better comprehend your symptoms and treatment options.

By combining a comprehensive diagnosis with an understanding of your thoracic spine, you can make informed decisions about your treatment and recovery plan.

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 of the thoracic spine (T11 and T12) and the first vertebra of the lumbar spine (L1).

Learn more about the anatomy of the thoracic spine. 

How Do Compression Fractures Typically Occur in the Spine?

Compression fractures in the spine usually happen due to excessive pressure on the vertebral body. These fractures often arise from a mix of forward bending and downward force exerted on the spine.

Common Scenarios Leading to Compression Fractures:

Falls:

• Imagine falling while seated, landing abruptly on your buttocks. This abrupt impact forces your upper body forward as your lower body hits the ground. The resulting forward flexion of the spine puts significant pressure on the anterior part of the vertebrae.

Physical Impact:

• Any event that combines downward force and forward flexion, such as a collision or a fall, can generate enough stress to cause a fracture. The vertebral bodies, primarily the cancellous bone inside, get compressed under this stress.

Bone Structure Compromise:

• When the pressure is too great, the vertebral body can collapse, forming a wedge shape. In severe cases, the back of the vertebral body can push into the spinal canal, potentially impacting the spinal cord.

Key Points:

• Forward Bending: This movement is a primary contributor to the pressure on the vertebrae.
• Downward Force: Coupled with forward bending, this can lead to fractures.
• Bone Compression: The cancellous (spongy) bone inside the vertebra can get crushed under extreme pressure.

By understanding these mechanisms, it’s clear that maintaining good spinal health and practicing safe movements can help mitigate the risks of compression fractures.

The Role of Bracing in Treating Vertebral Compression Fractures

Support and Stability

Bracing plays a crucial role in the treatment of vertebral compression fractures by providing essential support to the back. A back brace, also known as an orthosis, is often prescribed by doctors to help stabilize the spine. By restricting movement, much like a cast for an arm fracture, the brace ensures the affected area remains immobile.

Proper Alignment

One key function of the brace is to maintain proper spinal alignment. Designed to hold your spine in a position known as hyperextension—where the spine is straighter than usual—the brace minimizes pressure on the fractured vertebrae. This specific alignment is crucial for preventing further collapse of the bone and promoting effective healing.

Minimizing Movement

The brace works to restrict forward bending, which can exacerbate the fracture. By limiting this movement, the brace significantly reduces the chances of additional injury and protects the vertebrae from further damage. In essence, it creates a stable environment for the bone to heal more efficiently.

Healing Facilitation

With reduced pressure and limited movement, the vertebrae have a better chance to heal properly. The brace not only aids in recovery but also ensures that the healing process is not interrupted by accidental movements that could worsen the injury.

Summary

In summary, a back brace is an indispensable component in the treatment of vertebral compression fractures. It offers the necessary support, maintains proper alignment, minimizes harmful movements, and facilitates healing, thus ensuring a more effective and safer recovery process.

Learn more about bracing

Causes

Spine compression fractures 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 body.

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.

In advanced stages of osteoporosis, even everyday activities can lead to vertebral fractures. Actions that wouldn’t typically cause harm—like sneezing, coughing, or simply turning over in bed—can become risky. The brittle and weakened bones are highly susceptible to breaks under minimal stress. Therefore, it’s crucial for patients to know the risks and manage osteoporosis carefully to prevent such incidents.

How Can a Compression Fracture Lead to Spinal Stenosis?

When a compression fracture occurs, it can set off a chain reaction affecting the spinal nerves. Even after the fracture heals, irritation to these nerves can still happen, causing persistent pain and functional issues. One main problem is the reduced space in the spinal canal. This cramped environment can limit the blood flow and oxygen supply to the spinal cord, particularly during periods of increased activity. When the spine needs more blood, the restricted vessels can’t expand sufficiently to meet the demand, resulting in numbness and pain in the affected nerves.

Furthermore, with less room to move, the nerves lose some of their flexibility. This lack of movement causes nerve irritation and inflammation, contributing to ongoing discomfort. Over time, these factors can collectively result in a condition known as spinal stenosis, characterized by severe nerve pain and restricted mobility.

Osteoporosis

Osteoporosis primarily affects postmenopausal women over the age of 50, making them highly susceptible to vertebral compression fractures. However, it’s not just limited to this group; individuals between 40 and 50 years old are also at a considerable risk. Men over the age of 50, while less affected than women, can still commonly develop osteoporosis.

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 vertebral fracture causes loss of body height and a humped back (kyphosis), especially in elderly women. If the entire bone breaks, rather than just the front of the vertebra, it may be called a crush fracture. This type of fracture can lead to significant changes in posture and overall spine health, making it crucial to address and treat promptly.

Such fractures are common among individuals with osteoporosis, where the bones become brittle and more prone to breaking. Early detection and intervention can help mitigate the severe impacts on mobility and quality of life.

Understanding the Risk Factors for Osteoporosis and Related Fractures

Osteoporosis is a condition that predominantly affects postmenopausal women, but many people are unaware that it poses a significant risk to men as well. This debilitating disease weakens bones, making them more prone to fractures, particularly in the spine and hips.

Key Risk Factors

• Age and Gender:
  • Postmenopausal Women: Women are at a higher risk, especially after menopause due to a drop in estrogen levels. It’s estimated that about 25% of postmenopausal women in the U.S. Have experienced a vertebral compression fracture.
  • Men Over 50: Men are not immune. Roughly 25% of men over the age of 50 may suffer a bone fracture related to osteoporosis, showcasing the disease’s broad impact.

  Family History:

  • Genetics: If you have a family history of osteoporosis or frequent bone fractures, you’re more likely to develop the condition yourself.

  Lifestyle Factors:

  • Diet: Poor calcium and vitamin D intake weaken bone health.
  • Physical Activity: A sedentary lifestyle contributes to bone density loss. Weight-bearing exercises can help maintain strength.
  • Smoking and Alcohol: These habits can accelerate bone loss and increase fracture risks.

  Medical Conditions and Medications:

  • Chronic Diseases: Conditions like rheumatoid arthritis, celiac disease, and hormonal disorders can impact bone density.
  • Medications: Long-term use of corticosteroids and some anticonvulsants can lead to bone weakening.

  Body Weight:

  • Underweight: Low body mass index (BMI) is a significant risk factor. Thin individuals have less bone mass to begin with and are more susceptible to bone loss.

Preventative Measures

To mitigate these risks, consider incorporating calcium-rich foods like dairy products, leafy greens, and fortified cereals into your diet. Engage in regular physical activities such as jogging, walking, or strength training. Avoid smoking and excessive alcohol consumption. If you have underlying health issues or need medications that affect bone density, consulting a healthcare provider for appropriate tests and treatments can make a crucial difference.

Understanding these risk factors can empower you to take preventive actions against osteoporosis and its related fractures, ensuring better long-term bone health.

Utilizing subheadings, short paragraphs, and lists, this rewritten article is designed for optimal readability and user engagement. If you need a deeper dive into specific risk factors or additional details on prevention, let me know!

How Common Are Spinal Compression Fractures Due to Osteoporosis in the U.S.?

Spinal compression fractures linked to osteoporosis are a significant health concern in the U.S. Astonishingly, these fractures affect around 700,000 individuals each year. This prevalence underscores the importance of addressing bone health, especially among those who are at a higher risk for osteoporosis.

Key Points:

• Incidence: Approximately 700,000 new cases annually.
• Population at Risk: Primarily older adults, particularly postmenopausal women.

Considering these statistics, it’s crucial for at-risk populations to engage in preventive measures and regular screenings.

Trauma or an unknown cause

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 destroy part of the vertebra, weakening the bone until it collapses.

A compression fracture in the spine, occurring without any obvious injury or cause, can be a red flag for cancer that has metastasized to the spinal region. If a patient also shows symptoms like elevated calcium levels, unexplained anemia, significant weight loss, or the presence of abnormal proteins in the urine, it’s important to consider the possibility of cancer or multiple myeloma. These signs, alongside the fracture, can suggest that the cancer has been present but undiagnosed.

Metastatic tumors

Metastatic tumors can significantly impact the vertebrae in the spine, leading to potential fractures. When cancer spreads from its original site to the bones in the spine, it can compromise the structural integrity of the vertebrae. This weakening happens as the cancerous cells invade and replace the healthy bone tissue, making the bones more fragile and susceptible to breaks.

A particularly telling sign of this weakening is a compression fracture that occurs with minimal or no obvious cause. Such fractures might be the initial indication that cancer has metastasized to the spine. It’s crucial to consider this possibility, especially in patients exhibiting additional symptoms such as hypercalcemia, unexplained anemia, weight loss, or proteinuria. These symptoms, alongside a spine fracture, suggest that the cancer might have spread, necessitating prompt medical evaluation and intervention.

Symptoms

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 breaks, you will not feel any pain.

In very severe compression fractures, parts of the back of the vertebral body may protrude into the spinal canal and put pressure on the spinal cord. Fortunately, this does not normally occur. 

Diagnosis

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.

Physical Examination

During the initial visit, the physician will take a detailed medical history and perform a physical examination to rule out possible causes of pain and determine the exact issue. The areas of your body examined will depend on where you are experiencing pain—whether it’s your neck, lower back, arms, or legs.

If a compression fracture is suspected, the doctor will test for point tenderness near specific vertebrae. This helps narrow down the cause of your pain by identifying areas with unusual tenderness.

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. This is a painless process that uses radioactive materials to take pictures of bone. While X-rays are excellent for showing bones, they don’t provide much detail on soft tissues, making them especially useful when fractures are suspected.
• If the X-ray shows a fracture, your doctor may also suggest a CT scan to ensure the stability of the broken bone and that the nerves are not in danger. The CT Scan, which is an advanced form of X-ray, can show both bones and soft tissues and is capable of producing cross-sectional images. This allows each section of the spine to be examined separately. The CT scan can be combined with a myelogram if there are any concerns about the spinal cord. In cases of compression fractures, a CT scan helps piece together an up-and-down perspective of the spine to check for stability.
• Your doctor might recommend an MRI if a nerve injury is suspected or if questions still exist about the cause of any pain. The MRI is a newer test that uses magnetic and radio waves to create detailed images without radiation. It can cut through multiple layers of the spine, showing abnormalities in soft tissues such as nerves and ligaments.
• A bone scan might be ordered to help determine the age of a fracture. This test is particularly useful for identifying old fractures and assessing whether osteoporosis is a contributing factor. If the fracture appears old and other healed fractures exist, this observation may indicate osteoporosis, which is crucial 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.

In summary

These imaging tests—X-rays, CT scans, MRIs, and bone scans—each offer unique advantages in diagnosing and assessing vertebral compression fractures. By leveraging these technologies, doctors can provide a comprehensive evaluation and appropriate treatment plan tailored to each patient’s needs.

• 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’s 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.

Treatment Options

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 show promise in the treatment of vertebral compression fractures. Vertebral fractures usually take about three months to fully heal. X-rays will probably occur every month to check on the healing progress. Surgery for compression fractures rarely occurs.

Pain Medications

To control pain, doctors prescribe mild pain medicine. Remember that medicine will not help the fracture heal, but it can help control 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. This means they require extra care and a longer recovery period. Treat this fracture as you would any other broken bone—carefully and seriously.

Key points to remember:

• Avoid heavy lifting: This can place undue stress on your spine and hinder the healing process.
• Limit strenuous activities: Activities such as vigorous exercise can exacerbate the fracture.
• Consider bed rest if necessary: Especially for elderly patients, bed rest can mitigate risks associated with weaker bones.

By following these guidelines, you can help ensure a smoother and safer recovery.

Key points to remember:

• Avoid heavy lifting: This can place undue stress on your spine and hinder the healing process.
• Limit strenuous activities: Activities such as vigorous exercise can exacerbate the fracture.
• Consider bed rest if necessary: Especially for elderly patients, bed rest can mitigate risks associated with weaker bones.

By following these guidelines, you can help ensure a smoother and safer recovery.

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.

Surgical Treatment

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, our doctors consider two approaches — 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.

In some cases, an operation to stabilize the fractured vertebra can be performed through an incision in the back. This type of posterior approach allows the surgeon to use metal screws and metal rods to hold the vertebrae in the correct alignment while the fractured vertebrae heal. The posterior approach is particularly useful when there is not a great deal of pressure on the spinal cord, and the goal is to prevent the fractured vertebra from collapsing further.
By combining these methods, our surgical team ensures the best possible outcomes for patients suffering from severe spinal compression fractures.

Performing Surgery

Surgery to fix most spinal compression is rarely needed. With vertebral fractures, surgery or internal fixation is only considered if there is evidence of sudden and serious instability of the spine. For instance, if the fracture leads to a loss of 50% of the vertebral body’s height, surgery might be necessary to prevent more serious damage to the spinal nerves. By combining these approaches and criteria, we ensure that surgical intervention is only employed when absolutely necessary to protect your spinal health.

In some cases, an operation to stabilize the fractured vertebra can be performed through an incision in the back. This type of posterior approach allows the surgeon to use metal screws and metal rods to hold the vertebrae in the correct alignment while the fractured vertebrae heal. The posterior approach is particularly useful when there is not a great deal of pressure on the spinal cord, and the goal is to prevent the fractured vertebra from collapsing further. By combining these methods, our surgical team ensures the best possible outcomes for patients suffering from severe spinal compression fractures.

Postural Approach Surgery

In some cases, an operation to stabilize the fractured vertebra can be performed through an incision in the back. This type of posterior approach allows the surgeon to use metal screws and metal rods to hold the vertebrae in the correct alignment while the fractured vertebrae heals. The posterior approach is particularly useful when there is not a great deal of pressure on the spinal cord, and the goal is to prevent the fractured vertebra from collapsing further.
By combining these methods, our surgical team ensures the best possible outcomes for patients suffering from severe spinal compression fractures.

Surgery to fix most spinal compression is rarely needed. With vertebral fractures, surgery or internal fixation is only considered if there is evidence of sudden and serious instability of the spine. For instance, if the fracture leads to a loss of 50% of the vertebral body’s height, surgery might be necessary to prevent more serious damage to the spinal nerves. By combining these approaches and criteria, we ensure that surgical intervention is only employed when absolutely necessary to protect your spinal health.

Complications

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.

Learn more about possible complications of spine surgery.

Complications specifically related to a vertebral compression fracture include:

• segmental instability
• kyphotic deformity
• neurological complications

Segmental Instability

If a fracture leads to a vertebral body collapse of more than 50 percent, the 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.

Kyphotic Deformity

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.

Neurological Complications

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.

Consequences of Vertebral Fractures

Vertebral fractures are usually followed by acute back pain and may lead to chronic pain. These fractures can result in deformity, such as thoracic kyphosis (commonly referred to as a dowager’s hump), loss of height, and crowding of internal organs. Additionally, the lack of activity and exercise due to pain may lead to loss of muscle and aerobic conditioning.

A combination of these physical issues can lead to changes in an individual’s self-image. This shift in self-image can adversely affect self-esteem and the ability to carry on with daily activities.

It’s important to note that because the majority of damage is limited to the front of the vertebral column, the fracture is usually stable and rarely associated with any nerve or spinal cord damage.

Learn more about possible complications of spine surgery.

Why Choose the Southwest Scoliosis and Spine Institute?

The Southwest Scoliosis and Spine Institute with offices in  Dallas, Plano, and Frisco, Texas is a Premier Scoliosis Treatment Center.  We have top-rated, board-certified, fellowship-trained doctors who specialize in diagnosing and treating Scoliosis, Complex Spine Issues, and Spine Revision for both children and adults.

Finally, our doctors specialize in providing solutions even when other specialists claim nothing they can not.  Please note that we have successfully treated over 100,000 patients and carried out over 16,000 surgeries. We offer hope and deliver solutions.  Call us today.

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National Library of Medicine: Compression Fractures