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Spinal compression fractures occur when small hairline fractures in the spinal bones eventually cause a vertebra to collapse. The tiny fractures may permanently alter the strength and shape of the spine, causing patients to lose height. Most occur in the front of the vertebra, which causes the front part of the bone to collapse, resulting in a wedge-shaped vertebra. This causes patients to stoop forward, a condition called kyphosis, or dowager’s hump.
Most compression fractures in women over the age of 50 are related to osteoporosis. It is also a symptom of patients with cancer that has spread to their bones. A common symptom of spinal compression fractures is back pain. But many of these fractures are never diagnosed because patients think back pain is a regular sign of aging and don’t seek treatment.
At UPMC, neurosurgeons treat the majority of spinal compression fractures with pain medication, reduction in physical activity, medication to stabilize bone density, and back bracing to minimize motion during the healing process. Surgery is recommended when chronic pain from a spinal compression fracture persists despite non-surgical treatments. Minimally invasive surgery such as vertebroplasty or kyphoplasty may be used to treat spinal compression fractures. Spinal fusion surgery is also sometimes performed to stabilize the spine.
Patients with spinal compression fractures may feel pain that subsides as the bone heals. Others will continue to feel pain, even after the fracture has healed. However, not everyone with spinal fracture feels pain. Some people may feel pain in the abdomen rather than in the back, as a result of the spine compressing the internal organs.
Symptoms may include:
To diagnose a spinal compression fracture, the doctor will perform a physical exam and ask the patient about his or her pain and other symptoms. The doctor may also order x-rays, CT scans or MRI studies. If the doctor suspects the fracture is caused by cancer, he or she may order a bone biopsy.
At UPMC, we treat the majority of spinal compression fractures with pain medication, reduction in activity, medication to stabilize bone density, and back bracing to minimize motion during the healing process. Pain medications may include acetaminophen and non-steroidal anti-inflammatory drugs (NSAIDs). Narcotics and muscle relaxants are often prescribed for short periods of time, and antidepressants can also help relieve nerve-related pain. If osteoporosis has caused the fracture, treatment generally includes bone-strengthening drugs such as bisphosphonates to help stabilize or restore bone loss and prevent further fractures.
Surgery is only recommended when chronic pain from a spinal compression fracture persists despite non-surgical treatments. Surgery may include spinal fusion surgery or minimally invasive surgery such as vertebroplasty or kyphoplasty. In vertebroplasty and kyphoplasty, a small incision is made in the back and an acrylic bone cement is inserted into the spinal bone. Once it hardens, it helps stabilize the vertebra and spine. Most patients go home the same day or after one night’s stay in the hospital.
Spinal fusion surgery is sometimes used to eliminate motion between two vertebrae and to relieve pain. This procedure connects two vertebrae together with metal screws until they have a chance to fuse together.