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    Compression fractures of the back

    Vertebral compression fractures

    Compression fractures of the back are broken vertebrae. Vertabraeare the bones of the spine.

    Causes

    Compression fractures of the vertebraecan be caused by:

    • Osteoporosis (the most common cause),
    • Trauma to the back
    • Tumors that started in the bone or spread to the bone from elsewhere
    • Tumors that start in the spine, such as multiple myeloma

    Having manyfractures of the vertabrae canlead to kyphosis. This isa hump-like curvature of the spine.

    Symptoms

    Compression fracturescan occur suddenly. This cancause severe back pain that is:

    • Most commonly felt in mid to lower part of the spine. It can also be felt on the sides or in the front of the spine.
    • Knife-like in feelingand is often disabling, taking weeks to months to go away

    Compression fractures due to osteoporosis may cause no symptoms at first and may only be discovered when x-rays of the spine are done for other reasons. Over time, the following symptoms may occur:

    • Back pain that starts slowly, which gets worse with walking but is not felt when resting
    • Loss of height, as much as 6 inches over time
    • Stooped over posture, or kyphosis, also called a dowager’s hump

    Pressure on the spinal cord from hunched over posture can in rare cases cause:

    • Numbness
    • Tingling
    • Weakness
    • Difficulty walking
    • Loss of control of the bowel or bladder

    Your doctor will perform a physical exam. This may show:

    • A humpback, or kyphosis
    • Tenderness over the affected spinal bone or bones

    A spine x-ray shows at least one compressed vertebra that is shorter than the other vertebrae.

    Other tests that may be done:

    • A bone density test to evaluate for osteoporosis
    • A CT or MRI scan if there is concern that the fracture was caused by a tumor or severe trauma (such as a fall or car accident)

    Treatment

    Most compression fractures are seen in older people with osteoporosis. These fractures often do not cause injury to the spinal cord. The condition is usually treated with medicines and calcium supplements to prevent further fractures.

    Pain may be treated with:

    • Pain medicine
    • Bed rest

    Other treatments may include:

    • Back braces, but these may further weaken the bones and increasethe risk of more fractures
    • Physical therapy to improve movement and strength around the spine
    • A medicine called calcitonin to help relieve bone pain

    Surgery may be done if you have severe and disabling pain for more than 2 monthsthat does not get better with other treatments.Surgery can include:

    • Balloon kyphoplasty
    • Spinal fusion

    Other surgery may be done to remove bone if the fracture is due to a tumor.

    After surgery you may need:

    • A brace for 6-10 weeks if the fracture was due to an injury
    • More surgery to join spine bones together or to relieve pressure on a nerve

    Outlook (Prognosis)

    Most compression fractures due to injuryheal in 8 - 10 weeks with rest, wearing a brace, and pain medicines. However, recovery can take much longer if you had surgery.

    Fractures due to osteoporosisoften become less painful with rest and pain medicines. Some fractures, though, can lead to long-term (chronic) pain and disability.

    Medicines to treat osteoporosis can help prevent future fractures. But they cannot reverse damage that has already occurred.

    For compression fractures caused by tumors, the outcome depends on the type of tumor involved. Tumors that involve the spine include:

    • Breast cancer
    • Lung cancer
    • Lymphoma
    • Prostate cancer

    Possible Complications

    Complications may include:

    • Failure of the bones to fuse after surgery
    • Humpback
    • Spinal cord or nerve root compression

    When to Contact a Medical Professional

    Call your health care provider if:

    • You have back pain and you think you may have a compression fracture
    • Worsening symptoms or difficulty with controlling your bladder and bowel function

    Prevention

    Treating and preventing osteoporosis is the most effective way to prevent these fractures.

    References

    Cornell CN, Sculco TP. Orthopedic disorders. In: Duthie EH, Katz PR, Malone ML, eds.Practice of Geriatrics.4th ed. Philadelphia, PA: Elsevier Saunders; 2007:chap 37.

    Klazen CA, Lohle PN, de Vries J, et al. Vertebroplasty versus conservative treatment in acute osteoporotic vertebral compression fractures (Vertos II): an open-label randomised trial. Lancet. 2010 Sep 25;376(9746):1085-92.

    Wardlaw D, Cummings SR, Van Meirhaeghe J, et al. Efficacy and safety of balloon kyphoplasty compared with non-surgical care for vertebral compression fracture (FREE): a randomised controlled trial. Lancet. 2009;373(9668):1016-24.

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          Review Date: 11/15/2012

          Reviewed By: C. Benjamin Ma, MD, Assistant Professor, Chief, Sports Medicine and Shoulder Service, UCSF Department of Orthopaedic Surgery. Also reviewed by A.D.A.M. Health Solutions, Ebix, Inc., Editorial Team: David Zieve, MD, MHA, David R. Eltz, Stephanie Slon, and Nissi Wang.

          The information provided herein should not be used during any medical emergency or for the diagnosis or treatment of any medical condition. A licensed medical professional should be consulted for diagnosis and treatment of any and all medical conditions. Links to other sites are provided for information only -- they do not constitute endorsements of those other sites. © 1997- A.D.A.M., Inc. Any duplication or distribution of the information contained herein is strictly prohibited.
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