What is a Vertebral Compression Fracture?
Vertebral compression fractures explained by Denver, Golden, Aurora, Boulder, Broomfield, Jefferson, and Littleton Colorado’s top pain doctors
Vertebral compression fracture is the collapse of a vertebra (spinal bone). Defects or weaknesses in these bones cause them to shorten in comparison to normal, healthy vertebrae. These accumulate until cracks develop in the vertebra. As a result, the bone is not strong enough to maintain integrity (i.e. the normal height and conformation) of its region of the spine. This causes visible hunching or shortening of the spine. Vertebral compression fractures may occur in any area of the spine, particularly the thoracic and lumbar regions. Compression fractures of the cervical vertebrae (i.e. in the neck) may also impact painfully on the joints between vertebrae. Cracked vertebrae may also compress the spinal cord, causing chronic pain.
Causes of Vertebral Compression Fractures
Vertebral compression fractures are associated with osteoporosis; a progressive decrease in bone density. This can also be caused by osteolysis, a degeneration of bone tissue over time, caused by certain types of cancer spreading to the vertebrae or spinal cord. Compression fractures are commonly linked to advanced age. They can also be caused more immediately by falls from a height, particularly if they involve significant downward force, i.e. sustained by landing on the feet. They are also associated with motor vehicle accidents. Compression fractures may be accompanied by sharp, stabbing pain that often becomes chronic. They may even lead to paralysis or spinal cord injury unless repaired.
Treatment for Vertebral Compression Fracture
If the pain associated with compression fractures is not severe, it may be controlled with over-the-counter analgesics such as non-steroidal anti-inflammatory drugs (NSAIDs). Opioids, such as codeine or oxycodone, can be prescribed for compression fractures. These are associated with high risks of abuse, addiction, and tolerance however.
Vertebroplasty is a minor surgical procedure that corrects compression fractures effectively. First, the skin above the broken bone is anesthetized. A needle is inserted into the vertebra in question, and medical cement is injected through it. This seals the fracture, and repairs vertebral integrity, which restores lost height and corrects posture. Kyphoplasty is another variation of this procedure, in which one or two small balloons are inserted through the needle, and inflated to support the bone and restore height. Vertebroplasty and kyphoplasty have minimal risks of bleeding and infection at the needle insertion site. There is also a risk of cement leak that can cause damage and inflammation to the surrounding tissue, which creates the potential for further pain. These procedures are common in patients with bone density loss caused by spinal tumors or bone cancer. Kyphoplasty may be associated with more rapid decreases in chronic pain and recovery time in comparison with more traditional vertebroplasties.
Vertebroplasty or kyphoplasty can be complemented by other pain-relieving procedures for maximum pain relief. An example of these are nerve-blocking injections, in which local anesthetics such as lidocaine and/or steroids, are delivered directly to spinal nerves that send painful stimuli from compression fractures to the brain. Nerve blocks can be performed on the neck or back, and significantly reduce pain in cases of vertebral compression fractures. Facet joints between cracked vertebrae can be injected with similar formulations, which effectively reduce pain. These injections are effective and safe in over 90% of cases, though there are risks associated with these procedures. These include adverse reaction to the drugs injected, and temporary neurological complications such as chest discomfort and headache.
Radiofrequency ablation (RFA) involves the insertion of thin probes through the skin to the pain-conducting regions of spinal nerves. RFA, in conjunction with imaging techniques such as fluoroscopy, locate these specific areas and the probes are introduced to them under local anesthetic. These probes deliver electro-thermal impulses that destroy these regions and prevent the recurrence of pain for as long as several months following the procedure. RFA may cause infection, bleeding, and inadvertent nerve damage. This may cause numbness or paralysis, in the rare event that the wrong regions of spinal nerves are targeted.
Vertebral compression fractures are the collapse of vertebrae that is caused by defects in the bone. These are caused by a lack of bone density, which is normally associated with cancer or osteoporosis. Vertebral compression fractures are also associated with injury or trauma. They may cause height loss and visible hunching of the back. This condition is mostly associated with older people.
Pain related to compression fractures may be managed with conventional analgesics such as opioids and NSAIDs. Severely painful compression fractures may require surgery to repair them. These procedures, known as vertebroplasty or kyphoplasty, are the introduction of cement or supporting balloons into broken vertebrae to seal or lift breaks. Nerve-blocking injections or radiofrequency ablation often complement vertebroplasties to ensure long-term reduction of the pain associated with compression fractures.
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