Fracture of the vertebral body (broken bone) most commonly due to an event such as a traumatic injury. The trauma can range from a high impact injury such as a motor vehicle accident or fall, minor impact injury (such as minor fall in elderly patients with weakened bone due to osteoporosis) or compromised bone from tumor or radiation.
- Common terms: Insufficiency fracture
Pathophysiology: In a young adult with a significant mechanism of impact, this can occur similar to any other broken bone when the force of impact is greater than the structural strength of bone. In elderly patients with osteoporosis, compression fractures occur because the bone is weakened by the disease and therefore is not as strong. Therefore smaller impacts (such as falls, lifting heavy objects, sudden forceful movements, and even a sneeze) can cause the vertebra to fracture.
- Back pain: Usually focal in nature to the affected vertebra
- Leg pain/ muscular weakness: These may be signs that there is compression of the nerve roots or spinal cord. weakness because urgent surgical intervention may be needed.
- Case example: Vertebral compression fracture of L1
- 78year-old female with osteoporosis has sudden onset, acute back pain while trying to lift a heavy box. The pain is in the upper back and worsens when trying to move around.
Diagnosis: Xrays help to visualize the fractured bone. However, an xray does not tell one how old the fracture is so an MRI is usually ordered as well. An MRI can also help to evaluate for any compression of the spinal cord or nerves.
- Non-operative: Fortunately, most VCF’s heal without surgical intervention. Bracing helps for symptomatic relief but also for theoretical prevention of the bone from collapsing more. The acute pain usually decreases over the first few weeks of the injury and the bone will be healed in three to six months. Repeat x-rays will be done periodically to assess healing of the fracture and spinal alignment.
- Operative: When the pain is too severe for the patient to mobilize or perform their activities of daily living, then a kyphoplasty procedure may be warranted. This can also be performed to reduce risk of further collapse of the vertebra. Kyphoplasty is the insertion of bone cement into the vertebral body after expanding the body with a balloon. If there is significant compression of nerves or spinal cord by the fractured bone, then a decompression with fusion may be needed.