Spinal Compression Fracture

Spinal compression fractures, as their name implies, occur when the bones within one or more vertebrae collapse. These usually occur on the front of the vertebrae, as the back of the vertebrae is made of harder bone.

A spinal compression fracture can occur when too much pressure is placed on a weakened vertebra. This continued pressure weakens the vertebrae and, over time, can cause a buildup of minor fractures. If these small fractures continue to accumulate, they can eventually lead to the collapse of that vertebra – known as a compression fracture.

Spinal compression fractures commonly occur in people with osteoporosis, as their bones are weak and brittle, making them more susceptible to damage. Vertebral compression fractures, while sometimes linked to degenerative changes to the spine, can also be caused by metastatic tumors that put pressure on the vertebrae or by trauma resulting from a sports injury, car accident, or hard fall.

Several symptoms may occur as a result of spinal compression fractures, such as:

• A severe and sudden onset of back pain
• Intense pain when standing or walking
• Limited spinal mobility
• Eventual deformity, disability, and height loss

Spinal compression fractures can happen during everyday activities in people with severe osteoporosis. Anything from sneezing too hard to lifting a light object can cause spinal compression fractures. For people with more moderate osteoporosis, spinal compression fractures may occur from falling or attempting to lift a heavy object. People with osteoporosis who have had spinal compression fractures in the past are five times more likely to sustain a second spinal compression fracture in the future. It's worth noting that even if a spinal compression fracture has little to no symptoms at all, the risk of having additional fractures dramatically increases.

Nonsurgical Treatment Options for Spinal Compression Fractures

For those who already have a spinal compression fracture, there are nonsurgical methods that may help you recover. These treatment options fall into the following categories:

• Activity reduction or modification. Your doctor may recommend prolonged bed rest to reduce pain. While this can help in the short term, extensive bed rest can eventually cause more harm than good. This is because the reduced movement can further weaken the bones, potentially causing more compression fractures in the future.
• Back braces. Your healthcare provider may prescribe you a back brace to provide external support to your spine and reduce its range of motion. Because back braces limit the degree of movement your spine has, they can reduce the pain caused by spinal compression fractures as well. That being said, back braces should only be used under the supervision of a doctor, as extensive use of a back brace can cause muscle loss which can exacerbate the pain of spinal compression fractures.
• Pain management. Doctors may recommend over-the-counter medications to help relieve your pain. Specialists would carefully prescribe these medications to reduce muscle, nerve, and bone-on-bone pain. Depending on the severity of the compression fracture, prescriptions for narcotics and muscle relaxants may be necessary for a short time. However, due to their addictive nature, your healthcare provider would eventually replace narcotics with non-addictive over-the-counter medications such as acetaminophen. Specialists may also prescribe long-term antidepressants as they can relieve nerve-related pain.

Surgical Treatment for Spinal Compression Fractures

In severe cases, surgical treatment may be necessary to reduce pain caused by spinal compression fractures. There are several surgeries that may help you find relief:

• Vertebroplasty. This procedure helps relieve pain from spinal compression fractures by stabilizing them. A needle filled with a bone cement mixture is inserted into the damaged vertebrae and released. The mixture hardens after 10 minutes or so, and the patient can often go home the same day. 
• Kyphoplasty. This procedure can help correct the bone deformity caused by spinal compression fractures. A tube is inserted into the damaged vertebrae with a small balloon attached to the end. The balloon is inflated, allowing the surgeon to gauge how much bone cement must be injected. After measuring how much cement is needed, the balloon is removed, and the cavity is filled with bone cement, restoring the vertebrate to its original height and shape. The bone cement hardens within 10 minutes. Similar to vertebroplasty, the recovery time is minimal.
• Spinal Fusion Surgery. Spinal fusion surgery is often used as a last resort. The procedure fuses two or more vertebrae, reducing the pain caused by spinal compression fractures. In this procedure, metal screws are placed through a small tube of bone and into the damaged vertebrae. The screws are then attached to metal rods bolted together in the back of the spine. This stops spine movement, giving the damaged vertebrae a chance to fuse as they heal. Finally, bone is grafted into the spaces between the vertebrae. This procedure is more invasive and may require a three- to four-day hospital stay to recover. Additionally, you may need physical therapy to regain full movement.

There are several ways to help prevent spinal compression fractures, and all of them aim to strengthen your bones. Natural methods include taking calcium supplements, taking more vitamin D, avoiding smoking, preventing falls, and doing strength-building exercises. Some medications can help prevent spinal compression fractures as well. Medications that can help with bone fractures are as follows:

• Bisphosphonate drugs, such as ibandronate, can slow bone loss, improve their density, and help prevent fractures. 
• Teriparatide is a synthetic hormone that promotes bone growth and reduces spinal fractures in women with severe osteoporosis. 
• Raloxifene is a drug that acts similarly to estrogen, slowing bone loss and increasing bone thickness. 
• Zoledronic acid is a unique drug, given only once a year via a 15-minute transfusion. It can increase bone strength and reduce fractures in the legs, ribs, arms, wrists, hips, and spine. 
• Denosumab is an antibody drug that can decrease the risk of bone fractures, but specialists often reserve it for people at high risk.

Remember to discuss medicinal solutions with your doctor to find the proper preventative treatment for you.