Vertebral Fractures
Our spinal column is a beautifully complex structure that consists of 33 vertebrae in five distinct sections. Each of these vertebrae are connected by facet joints that are bound by tendons and ligaments.
Intervertebral discs cushion the movement between your vertebrae. The bony spine is positioned so that individual vertebrae provide a flexible support structure while also protecting the spinal cord.
Vertebral body fracture is a fracture of the thick oval bone (the vertebral body) that forms the front of each vertebra. This fracture eventually causes the vertebra’s collapse. The result is pain that may be relieved by lying down but that increases with activity and eventually becomes immobilizing.
These fractures occur most often in the middle of the back (the thoracic spine). Vertebral body fracture is common as we get older, with a major risk factor being age.
Healthy bones are able to withstand the normal amount of pressure exerted on them. Those in the spine are designed to provide strength, flexibility, and support to the spinal canal. However, if the force put on the vertebrae exceed the threshold they can tolerate, or the threshold is lowered due to problems, the vertebrae can fracture and collapse.
In particular, as we age the weight of our upper body can become more than the spine’s ability to support it. If the bones weaken, this increases the risk. As we age, the risk of vertebral body fracture jumps from 3% to 19% in women and from 7.5% to 20% in men.
Osteoporosis is a disease that affects bone density. It’s frequently seen in postmenopausal women and some older men. The bones become thin and weak and are more prone to fractures. Vertebral body fracture is most often diagnosed in patients with pre-existing osteoporosis.
In addition to osteoporosis, there are two other risk factors or underlying conditions that can cause vertebral body fracture.
Metastatic cancer that spreads to the vertebrae
The boney spine is a common place for certain cancers to spread to. The lytic lesions in the spine cause weakness and may eventually cause collapse of the vertebrae.
Any cancer patient who has a sudden onset of back pain or lower extremity neurological change should be immediately evaluated for metastatic disease.
Trauma or injury to the spine
Another cause of vertebral compression fractures is trauma to the vertebrae (e.g., blunt trauma, a fall, or motor vehicle accident). Any force that surpasses the ability the spine is able to support can cause collapse of the vertebrae.
All patients over the age of 50 who present with a sudden and acute onset of lower back pain should be evaluated for vertebral body fractures. The first step is a complete physical exam, looking for tenderness over the vertebrae as well as kyphosis (curving of the spine). Your doctor will ask you about other related physical symptoms including constipation, loss of lower extremity reflexes, and loss of sensory function. They may also take X-rays. An X-ray can diagnose a vertebral body fracture if it finds the classic wedge-shaped vertebral body with a narrowed portion in the front. If the X-ray doesn’t find a fracture, your doctor may still order additional studies such as a MRI, CT scan, or bone scan.
It is important to address and treat any underlying causes of vertebral body fracture while also treating the fracture itself. There are six common vertebral body fracture treatments. These range from conservative at-home care to more invasive options for severe fractures.
1. Pharmacologic treatments - Non-steroidal anti-inflammatory drugs (NSAIDs) and other over-the-counter analgesics can help manage acute pain. These may help relieve discomfort but do not correct the underlying problem causing the pain. Do note that an unfortunate side effect to NSAIDs is that they can increase gastrointestinal bleeding in the elderly. Only take them under your doctor’s care.
2. Bed rest - Short-term bed rest may help in the acute phase, but it is important to move as much as possible after the initial painful period has passed. Again, work with your doctor to find the appropriate amount of rest for your condition.
3. Exercise and physical therapy- Exercise and physical therapy, especially bodyweight exercises, are invaluable tools for healing (and preventing) vertebral body fractures. These also help increase muscle strength and flexibility that can decrease back pain associated with osteoporosis.
4. Osteoporosis treatments - There is good evidence that diagnosing and treating osteoporosis reduces the incidence of vertebral fractures of the spine. Certain treatments aiming to reduce the effects of osteoporosis include:
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Bisphosphonates
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Hormone replacement therapy
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Selective estrogen receptor modulators
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Calcitonin
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Calcium
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Vitamin D
5. Vertebroplasty - Vertebroplasty is a minimally invasive procedure that can help when more conservative measures do not relieve pain. This procedure involves injecting medical cement into the fractured vertebra to stabilize and strengthen the vertebrae.
6. Kyphoplasty - Likewise, kyphoplasty is a newer procedure that places an inflatable balloon into the vertebral body. When the balloon is inflated, it makes a space in the center of the vertebrae where medical cement is injected.
