Compression Fractures

Condition

Definition: These compression fractures can occur in vertebrae anywhere in the spine, but they tend to occur most commonly in the upper back (thoracic spine), particularly in the lower vertebrae of that section of the spine (e.g. T10, T11, T12). They rarely occur above the T7 level of the spine. They often occur in the upper lumbar segments as well, such as L1. A spinal fracture due to osteoporosis (weak bones) is commonly referred to as a compression fracture, but can also be called a vertebral fracture, osteoporotic fracture, or wedge fracture.

The term “wedge fracture” is used because the fracture usually occurs in the front of the vertebra, collapsing the bone in the front of the spine and leaving the back of the same bone unchanged. This process results in a wedge-shaped vertebra. A wedge compression fracture is generally a mechanically stable fracture pattern.

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

A combination of the above problems from vertebral fractures can also lead to changes in the individual’s self-image, which in turn can adversely affect self-esteem and ability to carry on the activities of daily living.

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.

Causes:

  • Osteoporosis – By far the most common cause of vertebral compression fractures, especially in women over the age of 50. It is also more common than most people think in people age 40-50, and it is reasonably common in men over age 50. Osteoporosis causes bones to thin and become more brittle and weak. The thinning bones can collapse during normal activity, leading to a spinal fracture. These compression fractures can cause a great deal of pain and can permanently alter the shape and strength of the spine.Spinal fractures due to osteoporosis often occur while doing something that causes relatively minor trauma to the spine, such as opening a window, an insignificant fall, or twisting while lifting.Advanced cases of osteoporosis can even lead to a vertebral fracture with routine activities that would normally not cause any trauma, such as sneezing, coughing, or turning over in bed.
  • Trauma – Trauma to the spinal vertebrae can also lead to minor or severe fractures. Such trauma could come from a fall, a forceful jump, a car accident, or any event that stresses the bones in the spine past its breaking point.
  • Cancer/Tumor – Some types of cancer can also cause a weakening of the vertebrae in the spine to the point where they may fracture. It is not uncommon for metastatic cancer that starts in another part of the body to spread to bones in the spine.A compression fracture of the spine that appears for little or no reason may be the first indication that an unrecognized cancer has spread to the spine. Cancer or multiple myeloma should be considered in patients who also have hypercalcemia, otherwise unexplained anemia, weight loss, or proteinuria.

From: Spine-health

Treatments

Kyphoplasty: a type of Vertebral Augmentation for Compression Fractures. The goals of a kyphoplasty surgical procedure are designed to stop the pain caused by a spinal fracture, to stabilize the bone, and to restore some or all of the lost vertebral body height due to the compression fracture.

Performing Kyphoplasty involves:

  • During kyphoplasty surgery, a small incision is made in the back through which the doctor places a narrow tube. Using fluoroscopy to guide it to the correct position, the tube creates a path through the back into the fractured area through the pedicle of the involved vertebrae.
  • Using X-ray images, the doctor inserts a special balloon through the tube and into the vertebrae, then gently and carefully inflates it. As the balloon inflates, it elevates the fracture, returning the pieces to a more normal position. It also compacts the soft inner bone to create a cavity inside the vertebrae.
  • The balloon is removed and the doctor uses specially designed instruments under low pressure to fill the cavity with a cement-like material called polymethylmethacrylate (PMMA). After being injected, the pasty material hardens quickly, stabilizing the bone.

Patients should not drive until they are given approval by their doctor. If they are released the day of the kyphoplasty surgery, they will need to arrange for transportation home from the hospital.

Facet Blocks Neck/Back: An injection of local anesthetic into a painful facet joint in the cervical, thoracic, or lumbar spine. A facet block usually has two goals: to help diagnose the cause and location of the pain and also to provide pain relief.

Typically, a mixture of anesthetic (such as lidocaine) and an anti-inflammatory medication (such as cortisone) is injected into the joint.

From: Spine-health

Staff

Jonathann Kuo, MD
Pain Medicine / Executive Director
Alexander Rances, DO
Pain Medicine / Medical Director
Robert Zhang, MD
Pain Medicine / Anesthesiology

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