A compression fracture can be a surprising thing, because sometimes you may not even be aware that damage has taken place and, upon an X-ray for a mysterious pain, you discover you have a fractured spine, usually as a result of the pressure that bones put on each other when osteoporosis weakens structure and movement.
This kind of fracture in the spine caused by osteoporosis is generally known 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.
While wedge fractures are the most common type of compression fracture, there are other types as well, such as:
- Crush fracture. If the entire bone breaks, rather than just the front of the vertebra, it may be called a crush fracture.
- Burst fracture. This type of fracture involves some loss of the height in both the front and back walls of the vertebral body (rather than just the front of the vertebra). Making this distinction is important because burst fractures can be unstable and result in progressive deformity or neurologic compromise.
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.
The problem is that the fracture is not always recognised or accurately diagnosed – instead, the patient’s pain is often just thought of as general back pain, such as from a muscle strain or other soft tissue injury, or as a common part of aging. As a result, approximately two thirds of the vertebral fractures that occur each year are not diagnosed and therefore not treated.
Treatments for spinal compression fractures
Medication: The majority of fractures heal with pain medication, reduction in activity, medications to stabilise bone density, and a good back brace to minimise motion during the healing process. Most people return to their everyday activities. Some may need further treatment, such as surgery.
Over-the-counter pain medications are often sufficient in relieving pain. Two types of non-prescription medications are recommended: acetaminophen and non-steroidal anti-inflammatory drugs (NSAIDs). Narcotic pain medications and muscle relaxants are often prescribed for short periods of time, since there is risk of addiction. Antidepressants can also help relieve nerve-related pain.
Reducing activity: Bed rest may help with acute pain, but it can also lead to further bone loss and worsening osteoporosis, which raises your risk for future compression fractures. Doctors may recommend a short period of bed rest for no more than a few days. However, prolonged inactivity should be avoided.
Back bracing: A back brace provides external support to limit the motion of fractured vertebrae – much like applying a cast on a broken wrist. The rigid style of a back brace limits spine-related motion significantly, which may help reduce pain.
Surgical Treatment for Spinal Compression Fractures
When chronic pain from a spinal compression fracture persists despite rest, activity modification, back bracing, and pain medication, then surgery is the next step.
Injection of bone cement: These procedures for spinal compression fractures involve small, minimally invasive incisions, so they require very little healing time. They also use acrylic bone cement that hardens quickly, stabilizing the spinal bone fragments and therefore stabilising the spine immediately. Most patients go home the same day or after one night’s hospital stay.
Spinal fusion surgery: This is a procedure used for spinal compression fractures to eliminate motion between two vertebrae, and thus relieve pain. The procedure connects two or more vertebrae together, holds them in the correct position, and keeps them from moving until they have a chance to grow together, or fuse. Metal screws are placed through a small tube of bone and into the vertebrae. The screws are attached to metal plates or metal rods that are bolted together in the back of the spine. The hardware holds the vertebrae in place. This stops movement, allowing the vertebrae to fuse. Bone is grafted into the spaces between vertebrae. Spinal fusion is often the last resort.
Recovery from spinal fusion surgery takes longer than with other types of spinal surgery. Rehabilitation is often necessary to rebuild strength and functioning. Depending on the patient’s age and health status, getting back to normal functioning can happen within two months or up to six months later.
Love your bones! Exercise gently, keep walking, and keep stretching to keep agile, mobile and flexible.
NOFSA (National Osteoporosis Foundation South Africa)
NOFSA is the only non-profit, voluntary health organisation dedicated to promoting lifelong bone health. We focus on reducing the widespread prevalence of osteoporosis while working to find a cure for the disease, and by supporting research and developing programmes of education and advocacy.
Find out more about our work at: www.osteoporosis.org.za