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What is the anatomy of the spine?
What are vertebral compression fractures?
What are the symptoms of vertebral compression fractures?
How are vertebral compression fractures diagnosed?
How are vertebral compression fractures treated?
What is the anatomy of the spine?
The spine is an intricate structure, made up of bones, muscles, and other tissues, which not only supports the upper body’s weight but also houses and protects the spinal cord -- the delicate nervous system structure that carries signals that control the body’s movements and convey its sensations. Stacked on top of one another are more than 30 bones (vertebrae) that form the spinal column. Each of these bones contains a round hole that, when stacked in register with all the others, creates a channel that surrounds the spinal cord. The spinal cord descends from the base of the brain and extends in the adult to just below the rib cage.
Small nerves enter and emerge from the spinal cord through spaces between the vertebrae. Because the bones of the spinal column continue growing long after the spinal cord reaches its full length in early childhood, the nerve roots to the lower back and legs extend many inches down the spinal column before exiting. This large bundle of nerve roots was dubbed by early anatomists as the cauda equina, or horse’s tail. The spaces between the vertebrae are maintained by round, spongy pads of cartilage called intervertebral discs that allow for flexibility in the lower back and act much like shock absorbers throughout the spinal column to cushion the bones as the body moves. Bands of tissue known as ligaments and tendons hold the vertebrae in place and attach the muscles to the spinal column.
Starting at the top, the spine has four regions: the seven cervical or neck vertebrae (labeled C1–C7), the 12 thoracic or upper back vertebrae (labeled T1–T12), the five low back or lumbar vertebrae (labeled L1–L5), and the sacrum and coccyx, a group of bones fused together at the base of the spine. The lumbar region of the back, where most back pain is felt, supports the weight of the upper body.
What are vertebral compression fractures?
In individuals with osteoporosis, the bones of the spine (vertebrae) may collapse within themselves and become compressed -- these fractures are called vertebral compression (crush) fractures. Bones affected by osteoporosis are less dense and weaker and, as a result, more susceptible to fractures even from a very slight force such as turning, bending, lifting, or even standing. Vertebral compression fractures are more likely to occur in the middle to lower back since these are the more weight bearing vertebrae.
What are the symptoms of vertebral compression fractures?
Some vertebral compression fractures may not cause any symptoms at all. Those that do, however, can lead to pain in the middle or lower back that can be sudden and sharp or may develop gradually. Pain can be either mild or severe and is generally worsened with sitting for a long time, standing, bending, twisting, walking, carrying heavy objects, sneezing, or coughing. Due to the collapse of the vertebrae after a fracture, patients may lose height and the back may become rounded and bent -- a condition termed kyphosis.
Rarely, vertebral compression fractures can damage the spinal cord or nerves and lead to symptoms such as weakness in the legs, numbness, loss of bowel or bladder control.
How are vertebral compression fractures diagnosed?
While the constellation of symptoms along with a physical examination can often help with the diagnosis of vertebral compression fractures, before starting treatment the diagnosis must be confirmed with the use of spine imaging. A variety of imaging techniques are available for this purpose and they include plain x-rays of the spine, computed tomography (CT), and magnetic resonance imaging (MRI) scans. Generally, any one of these imaging modalities is sufficient to confirm the diagnosis; however, additional testing may be needed if neurologic deficits (such as weakness) are present.
In addition, if osteoporosis is suspected, bone density may need to be measured and blood tests may be done to determine if any additional treatments are needed for the osteoporosis.
How are vertebral compression fractures treated?
The goals of treatment for vertebral compression fractures are to relieve pain, to return the patient back to their baseline level of function, and to prevent further fractures. Medications such as non-steroidal anti-inflammatory drugs (ibuprofen, naproxen, etc.) can be taken for pain relief; however, stronger (narcotic) medications may sometimes be needed for more severe pain.
A brace can sometimes improve pain while walking, but this is not always the case for more severe fractures. While a few days of bed rest may be needed to relieve the initial pain, it is important to resume walking and activity as soon as possible in order to avoid deconditioning, loss of further bone density, and further problems.
In case of more severe symptoms, some patients may be candidates for a minor surgical procedure called kyphoplasty where a special type of glue/cement is injected through the skin and into the collapsed vertebra using a needle. The cement hardens very quickly and stabilizes the fracture, thus, relieving pain -- sometimes immediately.
In cases where the fracture places pressure on the spinal cord or nerves, a more significant surgery (spinal fusion) may be needed to relieve the pressure as soon as possible to avoid significant deficits, such as permanent weakness or paralysis.
