Vertebral Compression Fracture

This is a collapse of vertebral bone. It can affect one or more vertebrae. Compression fractures typically develop in your mid or lower back. This can change the shape of your spine.

A vertebral compression fracture (VCF) is a fractured bone of the spine. The vertebrae are small, irregular-shaped bones that are stacked one on top of the other. In between the vertebrae are quarter-sized cushions known as discs. A vertebra fracture usually occurs due to weakened bones (osteoporosis), but trauma or excessive pressure can cause a VCF.

Where do VCFs occur?

The most common site of VCF is the lower thoracic (middle back) spine. The first seven vertebrae are the cervical spine, and they make up the neck region. The middle portion is the 12 thoracic vertebrae. The five lower vertebrae are the lumbar spine (lower back region).

How do VCFs occur?

Compression fractures generally occur due to pressure exerted on the vertebral body. A combination of bending forward and downward pressure will cause a VCF. Falling from a chair in a sitting position causes the spine to bend forward while pressure is on the front area of the spine. A fracture occurs when the anterior (front) part of the vertebra forms a wedge shape and crushing the cancellous bone (inside of the vertebra). Severe VCFs result in the back part of the vertebra to protrude into the spinal canal and press on the spinal cord.

What are the risk factors and causes of VCF?

There is no single cause of VCF. However, these fractures are highly associated with osteoporosis. Thinning of the bones makes them too weak to bear normal pressure and puts a person at risk for VCF. Osteoporosis is a disease that thins the bones, and VCF is the most common type of osteoporotic fractures. With severe cases of osteoporosis, simple actions can lead to a VCF, such as bending forward, sneezing, or falling on the back. Another cause of VCF is metastatic disease. Cancer cells often spread from other areas of the body to the bone. When cancer sets up in the bone, it weakens the bone, and the vertebrae are easily fractured.

How common are vertebral compression fractures?

Almost half of women have at least one spinal compression fracture by age 80 years.

What are the symptoms of VCF?

When the fracture is caused by a forceful, sudden injury, the patient often reports severe back pain. Depending on the site, the legs or arms may also hurt. Many patients also have numbness and/or weakness in the fracture location, as well as the extremities. In addition, the patient might not have any pain when the VCF occurs.

How is a VCF treated?

Treatment of VCF depends on the severity of the fracture, how long the fracture has been present, and the patient’s symptoms. Options include:

  • Medications – For mild pain, the doctor may recommend acetaminophen or ibuprofen, which can be purchased over-the-counter. For severe pain, narcotic analgesics are used short-term, such as codeine, hydrocodone, or tramadol.
  • Bracing – A brace is a well-molded device that conforms tightly to the patient’s body. Bracing is used for VCF to keep the patient from bending forward. A brace holds the spine in a hyperextended state, which means more straight than normal. This takes the pressure off the fractured bone so the vertebra can heal. Bracing also prevents further bone collapse.
  • Epidural steroid injection (ESI) – To stop the pain associated with a VCF, the doctor may use an epidural steroid injection. This involves injecting a corticosteroid into the epidural space, which is around the spinal cord. An anesthetic may be added for improved effectiveness.
  • Selective nerve root block – When nerve root compression occurs secondary to the VCF, a nerve block may be necessary. Using x-ray guidance, the doctor inserts a needle near the affected nerve. Then, he injects a long-acting anesthetic, corticosteroid, and/or neurolytic agent onto the nerve. This deactivates the nerve for several weeks to months.

Vertebroplasty/Kyphoplasty – When the VCF is new, the doctor can restore bone height with one of these procedures. With vertebroplasty, bone cement is injected into the collapsed vertebra. With kyphoplasty, a balloon is inflated to restore bone height, and cement is also injected to hold the bone in position.