• Compression fractures may occur with only slight trauma in older people with osteoporosis.
• The area around the fracture is painful, and the pain worsens with walking, standing, and prolonged sitting.
• Doctors diagnose spinal compression fractures with x-rays.
• Treatment can include braces, comfort measures, and sometimes injection of bone cement into the fractured bone.

In a compression fracture of the spine, the cylindrical-shaped part of the back bone (vertebra) that makes up the column of the spine and bears most of the weight, becomes compressed into a wedge shape. These fractures usually occur in older people, typically those with osteoporosis. Sometimes, cancer that has spread to the spine weakens it and causes compression fractures. Compression fractures of the spine can occur with slight trauma or even with lifting, bending forward, or taking a misstep. Sometimes people do not remember any event that might have caused the fracture.

Other fractures of the spine are discussed elsewhere (see Spinal Cord Disorders: Injuries of the Spinal Cord and Vertebrae).

Symptoms

Compression fractures cause constant, dull back pain that may worsen with standing, walking, or prolonged sitting. When the doctor gently taps over the spine, the person feels discomfort. Because the spinal cord and nerve roots are contained within the spine, the cord or nerve roots very rarely may be injured, which may result in paralysis and a loss of sensation. Other symptoms of nerve injury include pain radiating into the leg, weakness of the leg muscles, and involuntary wetting or soiling of clothing with urine or stool (incontinence).

If compression fractures occur over time at several levels of the spine, a person can lose several inches of height, develop a humpback deformity, and be unable to stand up straight.

Diagnosis

Doctors use x-rays to confirm the diagnosis, check the spine for stability, and exclude the possibility of cancer.

Treatment

Braces are most effective for fractures located in the lower part of the spine. They can relieve pain and enable the person to more rapidly return to daily activities. Initially, bed rest may be required for a few days, but sitting up and walking for short periods as soon as possible can help prevent loss of function and further loss of bone density.

In older people, compression fractures of the spine that are not complicated by instability, nerve injury, or cancer heal on their own but slowly. Treatment often is limited to comfort measures.

Two minimally invasive procedures can sometimes be done to help relieve pain and possibly restore height and improve appearance:

• Vertebroplasty: A material called polymethylmethacrylate—an acrylic bone cement—is injected into the collapsed vertebra. This procedure takes about an hour for each vertebra.
• Kyphoplasty: In this similar procedure, a balloon is inserted into the vertebra and is expanded to restore the vertebra to its normal shape. Then bone cement is injected.

Neither of these procedures reduces the risk of fractures in adjacent bones in the spine or ribs. This risk may even increase. Other risks may include leakage of the cement and possibly heart or lung problems.

Last full review/revision December 2008 by James R. Roberts, MD