Vertebral compression fracture explained

Vertebral compression fracture should not be confused with spinal disc herniation.

Compression fracture
Field:	orthopedic

A compression fracture is a collapse of a vertebra. It may be due to trauma or due to a weakening of the vertebra (compare with burst fracture). This weakening is seen in patients with osteoporosis or osteogenesis imperfecta, lytic lesions from metastatic or primary tumors,^[1] or infection.^[2] In healthy patients, it is most often seen in individuals suffering extreme vertical shocks, such as ejecting from an ejection seat. Seen in lateral views in plain x-ray films, compression fractures of the spine characteristically appear as wedge deformities, with greater loss of height anteriorly than posteriorly and intact pedicles in the anteroposterior view.^[3]

Signs and symptoms

Acute fractures will cause severe back pain. Compression fractures which develop gradually, such as in osteoporosis, may initially not cause any symptoms, but will later often lead to back pain and loss of height.

Diagnosis

Compression fractures are usually diagnosed on spinal radiographs, where a wedge-shaped vertebra may be visible or there may be loss of height of the vertebra. In addition, bone density measurement may be performed to evaluate for osteoporosis. When a tumor is suspected as the underlying cause, or the fracture was caused by severe trauma, CT or MRI scans may be performed.

Treatment

Conservative treatment

• Back brace for support while the bone heals—either a Jewett brace for relatively stable and mild injuries, or a thoracic lumbar sacral orthosis (TLSO) for more severe ones.^[4]
• Opioids or non-steroidal anti-inflammatory drugs (NSAIDs) for pain. For osteoporotic patients, calcitonin may be helpful.^{[5] [6]}

Surgical

• Kyphoplasty^[7] and vertebroplasty^{[7] [8]} are minimally invasive procedures that inject cement into the bone of the back that is fractured. However, the data examining the effectiveness of these procedures is mixed.^{[9] [10]}

Further reading

• 10.1001/jama.299.7.858 . Osteomyelitis . 2008 . Zeller . J. L. . Burke . A. E. . Glass . R. M. . JAMA . 299 . 7 . 858 . 18285597. free .
• Medscape article on lytic lesions
• Emedicine article on spinal metastasis

Notes and References

1. Web site: Kristy . Weber . February 28, 2006 . Rounds 2: Treatment of Metastatic Bone Disease . Johns Hopkins Arthritis Center.
2. Web site: Bone Infections . September 7, 2011 . MedlinePlus.
3. Book: Brant . William E. . Helms . Clyde A. . 2007 . Benign Compression Fracture . https://books.google.com/books?id=Sossht2t5XwC&pg=PA302 . Fundamentals of Diagnostic Radiology . 3rd . 302 . Lippincott Williams & Wilkins . Philadelphia . 978-0-7817-6135-2.
4. Web site: Jewett vs. TLSO Replies . OANDP-L on oandp.com . 2010-09-27 . 2012-09-02 .
5. Web site: Calcitonin for osteoporotic fractures . https://www.webarchive.org.uk/wayback/archive/20090608194055/http://www.medicine.ox.ac.uk/bandolier/booth/painpag/Chronrev/muscskel/CP104.html . dead . 2009-06-08 . 2012-09-03 .
6. 10.1007/s00198-004-1798-8 . Calcitonin for treating acute pain of osteoporotic vertebral compression fractures: A systematic review of randomized, controlled trials . 2004 . Knopp . Jennifer A. . Diner . Barry M. . Blitz . Maurice . Lyritis . George P. . Rowe . Brian H. . Osteoporosis International . 16 . 10 . 1281–90 . 15614441. 34208503 .
7. 10.1097/01.brs.0000244639.71656.7d . Balloon Kyphoplasty and Vertebroplasty for Vertebral Compression Fractures . 2006 . Taylor . Rod S. . Taylor . Rebecca J. . Fritzell . Peter . Spine . 31 . 23 . 2747–55 . 17077747. 209491 .
8. 10.1007/s00586-007-0308-z . Balloon kyphoplasty in the management of vertebral compression fractures: An updated systematic review and meta-analysis . 2007 . Taylor . Rod S. . Fritzell . Peter . Taylor . Rebecca J. . European Spine Journal . 16 . 8 . 1085–100 . 17277923 . 2200787.
9. 10.1007/s00198-011-1639-5 . Balloon kyphoplasty and vertebroplasty in the management of vertebral compression fractures . 2011 . Boonen . S. . Wahl . D. A. . Nauroy . L. . Brandi . M. L. . Bouxsein . M. L. . Goldhahn . J. . Lewiecki . E. M. . Lyritis . G. P. . Marsh . D. . Obrant . K. . Silverman . S. . Siris . E. . Åkesson . K. . Osteoporosis International . 22 . 12 . 2915–34 . 21789685. 8 . CSA Fracture Working Group of International Osteoporosis Foundation . 19967779 .
10. 10.1007/s00264-011-1283-x . Percutaneous vertebroplasty versus balloon kyphoplasty for treatment of osteoporotic vertebral compression fracture: A meta-analysis of randomised and non-randomised controlled trials . 2011 . Han . Shiliang . Wan . Shuanglin . Ning . Lei . Tong . Yongjun . Zhang . Jianfeng . Fan . Shunwu . International Orthopaedics . 35 . 9 . 1349–58 . 21637959 . 3167445.