Osteoporosis and Compression Fractures

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Osteoporosis is a metabolic bone disease that can devastate bone density, its core strength and increases the risk for bone fracture. In the spine, the bony vertebral structures in the cervical, thoracic, lumbar and sacral spine can be affected. One type of spinal fracture is a vertebral compression fracture (VCF). Traumatic forces incurred during a fall or simply bending at the waist may cause a sudden compression fracture in an osteoporotic spine marked by significant pain. A common scenario is a thoracic (mid back) compression fracture where, over time multiple fractures may create an abnormal kyphosis (a humpback appearance) that is often accompanied by disabling pain and nerve injury.
Illustration of a vertebral fracture causing spinal cord compression.Illustration of a vertebral fracture causing spinal cord compression.A spinal compression fracture results from tension from an external force (eg, injury). The compressive force can cause one or more spinal vertebrae to collapse, become wedge-shaped, crush, or burst. The fracture may compress nerve roots and/or move into the spinal canal compromising the spinal cord.

The foremost symptom of VCF is usually sudden onset of acute pain near the fracture (eg, neck, low back). Spinal fractures that compress nerves and/or the spinal cord can cause different symptoms that vary from mild to serious (eg, myelopathy).

Some vertebral compression fractures are considered stable, meaning the risk for bone to break away is low. However, progressive osteoporosis and/or combined with multiple VCFs may increase risk for a burst fracture. Sometimes, traumatic forces cause a burst fracture outright. These bony fragments can be forced into the spinal canal disrupting spinal cord function that may cause severe neurological dysfunction, such as paralysis—a spinal cord injury. A spinal cord injury may cause loss of strength, sensation, and/or reflexes at and below the level of injury.

Suspect a vertebral compression fracture? What you should do.
Traumatic accidents (eg, motor vehicle accident, fall) or events involving someone at risk for osteoporosis or who has incurred a previous spinal fracture require cautious care at the scene—even if the scene is at home. If possible, seek help from emergency medical personnel who are trained in measures to guard the spine during movement and transport to the emergency room. In general, if spinal fracture is suspected, the person should not move or be moved. Movement or sitting may increase the risk for neurologic injury.

How is a vertebral compression fracture diagnosed?
Following a physical and neurological assessment, plain x-rays are a first step in detecting and confirming VCF. It is normal for CT scan series to follow, and in some cases, such as neurological deficit, a magnetic resonance imaging (MRI) scan may be ordered to assess soft tissue damage, bleeding, and/or ligament disruption. These tests enable the doctor to determine the fracture type, location and structures involved, and severity (eg, spinal cord injury). These factors weigh into your doctor’s treatment decision-making process.

The patient’s medical history is considered, especially if osteoporosis (eg, bone mineral density, DEXA) was previously diagnosed with or without prior fracture (eg, spine, hip, wrist). A physical examination will help your doctor understand whether you have spinal deformity and/or tenderness at the fracture level. A neurologic exam includes testing muscle strength, sensation, reflexes of the lower extremities, and bowel and bladder control.

What are the treatment options for a VCF?
People who sustain a vertebral compression fracture may be referred to and/or treated by an orthopaedic spine surgeon, neurosurgeon or interventional spine specialist. The first-line therapy may include medications to help manage pain, such as an analgesic, anti-inflammatory and/or muscle relaxant.

The spine specialist may recommend a brace or corset to help immobilize the affected region of the spine during healing. Some patients simply cannot tolerate wearing an orthotic because of pain. Compression fractures occurring in the cervical spine may be immobilized using a Philadelphia Collar or other cervical brace.

Kyphoplasty and vertebroplasty are 2 different types of minimally invasive surgical procedures performed to treat vertebral compression fracture. Kyphoplasty employs balloon technology to help restore vertebral body height and shape, which is followed by injection of a bone cement to stabilize the fracture. Vertebroplasty, an older procedure, involves the injection of the bone cement into the vertebral bone fracture. Spine surgeons and interventional spine specialists perform these procedures and can make a recommendation as to which procedure may offer the patient an optimal outcome.

Physical therapy may be prescribed to help improve flexibility, rebuild strength, and increase range of motion. It is common for the treating physical therapist to provide the patient with stretching movements and exercises that can be performed at home.

Updated on: 06/26/18
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Compression and Wedge Fractures: Treatment and Recovery
Iain Kalfas, MD
Head, Section of Spinal Surgery
Dept. of Neurosurgery
Cleveland Clinic
Cleveland, OH
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Compression and Wedge Fractures: Treatment and Recovery

Osteoporosis may cause vertebral compression fractures and spinal wedge fractures. Balloon kyphoplasty and vertebroplasty are minimally invasive spine surgical procedures that are used to treat vertebral fractures, stabilize the spine and reduce back pain.
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