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Lumbar Compression Fracture

What is a Lumbar Compression Fracture?

A Vertebral Compression Fracture (VCF) is a collapse of a vertebra in the spine. The body of the vertebra which is the front section of the vertebra, collapses. Since the collapse of the vertebra is in the front of the vertebra, the spine often begins to curve forward.

Why do patients get a Vertebral Compression Fracture?

VCF’s are caused by too much pressure on the front of the vertebrae, or weakness of the vertebra. This can happen when the spine is bent forward (flexed) or too much weight is placed on the spine. This often causes the vertebral body to collapse in a wedge shape (smaller in front than back).

Less common is a burst fracture, where the vertebrae breaks off into pieces, some of which could cause compression of the spinal cord or spinal nerves.

While osteoporosis related VCF’s are the most common, they can also occur due to trauma or bone cancer.

Here are some of the common causes of Vertebral Compression Fractures:

  1. Accidents:
    1. Motor Vehicle Accidents
    2. Sports Accidents
  2. Osteoporosis or Spine Cancer related:
    1. A strong cough or sneeze
    2. Bending forward
    3. Lifting something heavier
    4. Fall

How common are Vertebral Compression Fractures?

It is estimated that 700,000 VCF’s occur each year in the U.S.. Studies have shown that up to 15% of women and 5-9% of men will have a VCF in their life time. 40% of women over the age of 80 will have a VCF. After having a VCF, the risk of having another one is 20% in the first year in women after menopause.

Where in the spine do Vertebral Compression Fractures usually occur?

VCF’s most commonly occur in the mid-back (thoracic spine), and low-back (lumbar spine).

The most common spinal levels affected are T7, T8, T12 and L1.

How long do Vertebral Compression Fractures take to heal?

This depends on the reason for the fracture. Fractures related to trauma and osteoporosis tend to heal within 8 weeks. Fractures related to cancer may not heal completely.

What are the common symptoms from a Vertebral Compression Fracture?

VCF’s may not cause symptoms. Here are some common symptoms for the ones which do:

  1. Sudden spine pain in the low back
  2. Pain in the spine worsened when bending down
  3. Worsened pain with standing, sitting or walking, improved when lying down.
  4. Muscle spasms on the sides of the spine
  5. Developing a “hump” in the back over time
  6. Loss of body height over time
  7. Pain spreading up and down the spine
  8. Pain, numbness and weakness in the legs (burst fractures)

How are Vertebral Compression Fractures diagnosed?

It is estimated that only 1/3rd of VCF’s are diagnosed. Part of the reason is that many VCF’s can cause very little or no pain at all.

  1. History

A history of a sudden onset of back pain especially in patient with known or suspected Osteoporosis can be a tip off for a VCF.

      2. Physical Examination

Here are some examinations the doctor may perform to help diagnose a VCF:

  1. Pushing and touching the spine (palpation) looking for pain, swelling and deformity
  2. Mobility testing (range of motion)
  3. Sensory (sensation) testing in the legs
  4. Muscle strength (motor) testing in the legs
  5. Reflex testing

      3. Imaging Tests

a. X-Ray

X-Rays of the spine can show the common “wedge fractures” seen in VCFs.

b. CT Scan

CT scans are excellent tools to see the bone anatomy of the spine. VCFs can be seen clearly. A burst fracture and its pieces can also be seen. This can help doctors understand if the spinal cord could be compressed. When combined with a myelogram, the spinal canal and spinal cord can be seen as well.

c. MRI Scans

MRI scans can show compression fractures. While MRI technology is not as good as a CT scan to show specific details of the vertebral bones, it is an excellent tool to see swelling inside a vertebrae from a VCF, and a potential compression of the spinal cord and spinal nerves.

d. Nuclear Bone Scan

Nuclear bone scans show the activity in a VCF which is created by the body’s attempt to heal it. It can be very specific for a VCF and show where in the spine it is located. However it cannot show any details about the fracture or the other structures which could be affected by it.

How are Compression Fractures treated?

    1. Non-Surgical Care

A. Activity Restriction

Typically for new compression fractures it is recommended to limit bending, twisting, lifting and any other higher impact activity such as running.

B. Alternative Health Care

Alternative Health care options can often complement conventional medical care. Massage Therapy, Acupuncture, Meditation exercises and Herbal Remedies can all help with the pain from this condition. Massage Therapy has to be done in a very gentle fashion to avoid placing pressure on the fractured area of the spine. It may be more useful for an older, healed fracture.

C. Nutrition and Weight Loss

Proper nutrition and weight loss can have a positive impact on many spine conditions. Excess weight on the spine often contributes to the symptoms of pain and spasms.

D. Chiropractic Care

Chiropractic care including manipulation and adjustments of the spine can help with the pain and spasms from this condition after the fracture is healed. Spine manipulation and adjustments are usually not recommended for a new fracture.

E. Spine Exercises

Spine exercises can help with the muscle pain and tightness from this condition. Exercise also increases the amount of oxygen delivered to the spine which can help with healing. Pilates, Yoga and T’ai Chi can help maintain the spine’s flexibility. Only very gentle types of simple stretching exercises are recommended for new fractures.

F. Physical Therapy (PT)

PT has many modalities to offer for this condition. They can range from gentle Manual Therapy and Exercises to gentle Traction and Ultrasound Treatments. PT can help mobilize patients who are suffering from the pain related to a VCF.

G.Self Help Tools

Self Help Tools are items which can be purchased to help with back pain. They range from Neck and Back Braces to Back Mattresses and Ergonomic Devices such as chairs and computer accessories. Back braces can help with the pain from the fracture and provide some stability while the fracture heals

H. Spine Medications

Here are some of the common groups of medications which are available for this condition:

1. Non-Steroidal Anti-Inflammatory Drugs (NSAIDS)

2. Muscle Relaxants

3. Pain Killers

4. Nerve Pain Medications

5. Topical Medications

I. Spine Injections

Here are some spine injections which can lessen the pain from a compression fracture:

  1. Lumbar Trigger Point Injections
  2. Lumbar Muscle Blocks
  3. Lumbar Interlaminar Epidural Steroid Injections

 

J. Minimally Invasive Treatments

Minimally invasive treatment options can help with the pain and instability of the vertebra from VCF’s. They inject bone cement into the fractured Vertebra.

  1. Lumbar Vertebroplasty
  2. Kyphoplasty

 

 

      2. Surgical

Surgical treatments for VCFs are usually only required for fractures which are creating pressure on the spinal cord or spinal nerves, or those resulting in a lack of stability of the spine. Typically, these types of fractures are the result of significant trauma or cancer.

Here are some of the examples of surgical options:

  1. Lumbar Vertebrectomy/Corpectomy
  2. Lumbar Laminectomy and Fusion
  3. Lumbar Fusion