What is a vertebral compression fracture (VCF)?
VCFs occur when the bony block part or vertebral body in the spine collapses or becomes squashed, which can lead to severe pain, deformity and loss of height. These occur most commonly in the thoracic (middle) or lumbar (lower spine) but it is possible to get a compression fracture anywhere in the spine.
How do vertebral compression fractures arise? Vertebral compression fractures can be linked to three potential causes:
Trauma: Individuals with healthy spines and bones will usually only succumb to a VCF through high force trauma such as a car accident, sports injury or a hard fall from a height.
Pathological: Sometimes these fractures can occur as a result of other underlying disease such as metastatic tumours, osteomyelitis (infection of the bone) or Paget’s disease.
Osteoporotic: Osteoporosis (weak or brittle bones due to reduces bone density) may increase the chance of sustaining a vertebral compression fracture without trauma. People with severe osteoporosis can sustain a VCF during daily acitivity such as stepping out of the shower, sneezing forcefully or lifting a light object.The risk of osteoporosis and therefore vertebral compression fractures increases in women post-menopause. Although far more common in women, VCFs are also a major health concern for older men.
What are the symptoms of a vertebral compression fracture?
There are a few possible symptoms of vertebral compression fractures which can include:
Sudden onset of back pain – especially in the mid to lower back.
Numbness, tingling and weakness – this can occur if the bony fragments from the fracture cause compression of the nerves at the fracture level.
Incontinence or urinary retention – this can occur if fracture fragments press on the spinal cord.
An increase of pain intensity while standing or walking
A decrease in pain intensity while lying on the back
Limited spinal mobility
Eventual height loss
Eventual deformity and disability
Vertebral compression fractures are diagnosed through imaging of the spine to assess the bones which may include and x-ray, CT scan or MRI scan. How are vertebral compression fractures treated? There are several treatment options for vertebral compression fractures:
Pain relief – including non-steroidal anti-inflammatories, muscle relaxants
Exercise – when approved by the doctor to prevent further osteoporosis and strengthen the muscles in the back
If the conservative treatments fail or the fracture is causing neurological problems there are surgical options including:
Kyphoplasty: A kyphoplasty aims to reduce or stop the pain back linked to a fracture. During the procedure the surgeon makes a small keyhole incision, they pass a narrow tube through this incision. Once the position of the tube is confirmed by x-ray images, the tube creates a pathway from the skin to the damaged vertebral body. The surgeon inserts a special balloon through the tube into the vertebra and gently inflates it. The balloon inflates and pushes a void in the soft bone to create a hollow space inside the vertebra. The surgeon removes the balloon and injects a cement-like material into the void via the tube. The cement hardens quickly once injected and stabilises the bone.
Vertebroplasty: A vertebroplasty aims to reduce or stop the pain back linked to a fracture. During the procedure the surgeon makes a small keyhole incision, they pass a narrow tube through this incision. Once the position of the tube is confirmed by x-ray images, the tube creates a pathway from the skin to the damaged vertebral body. The surgeon then injects a cement-like material into the void via the tube. The cement hardens quickly once injected and stabilises the bone.
Decompression: This is an operation done to relieve pressure on the spinal cord by removing some bone from the back of the spine.
How can you prevent vertebral compression fractures? Many vertebral compression fractures are a result of osteoporosis. So if the risk of osteoporosis can be reduced then the risk of VCR could be reduced. This can be achieved by:
Balanced diet with plenty of Calcium and vitamin D
Exercise especially weight bearing exercise