A vertebral compression fracture (VCF) occurs when the vertebra becomes compressed due to trauma. Significant trauma, osteoporosis, and other diseases such as cancer can lead to breakage of the vertebrae. Vertebrae in any part of the spine can be broken, but the most common are those in the lower back.
Symptoms and signs of a VCF include pain, numbness and incontinence. Pain associated with this condition is usually in the lower vertebrae, but may occur in other parts of the back or hip, abdomen or thigh. When nerves at the fracture site are compressed there also may be the sensation of numbness, tingling and weakness. Losing control of urine or stool or the inability to urinate can be symptoms when the fracture is pushing on the spinal cord.
WHEN AND HOW TO SEEK MEDICAL CARE
Doctor evaluation of back pain is necessary for these conditions:
- Elderly person age 65-years or older
- Children under 12-years of age
- A person with cancer
- A person experiencing the same level of pain at rest as it is during activity
- Unexplained or unintentional loss of weight
- Pain while sleeping is worse than when awake
- A person who had or has cancer
The following symptoms require medical attention through a hospital emergency department:
- Numbness, weakness and/or severe pain
- High fever, a temperature greater than 100.4 F or 38.0 C
TESTING AND DIAGNOSIS
Diagnosis can be made through patient history and a physical examination, x-rays, computed tomography or magnetic resonance imagery.
There are both non-surgical and surgical methods of treatment.
Pain secondary to acute vertebral fracture due to instability at the fracture site may be allowed to heal naturally. The VCF pain may last as long as three-months, but many experience improvement and lessening pain within a few days. Treatment of VCF includes reduction of activities, medication, and bracing.
Pain relieving over-the-counter medications can be effective in relieving pain. Muscle relaxants and other nerve/bone medications may be prescribed. Opioids should only be prescribed for acute pain over a short period of time, not longer than 1 to 2 weeks. In some cases, medications for bone strengthening known as bisphosphonates may be prescribed to help stabilize or restore bone loss.
If conservative treatment does not improve the condition, there are surgical options.
There are two minimally invasive procedures that may be used for VCF treatment, vertebroplasty and kyphoplasty.
Vertebroplasty is usually an outpatient treatment, although some patients stay overnight. Depending on the number of vertebrae that require treatment, the procedure may take 1 to 2 hours to perform under local anesthetic, intravenous sedation or general anesthesia. Vertebroplasty involves the surgeon injecting an acrylic bone cement in the collapsed vertebra to stabilize and strengthen the site. Relief from pain is believed to be achieved by the stabilizing of the fractured vertebra. The second type of surgical procedure is kyphoplasty may be used where height of the collapsed vertebrae requires restoration. Kyphoplasty uses a balloon to create a space which is filled with the acrylic cement.
The complication rates for vertebroplasty and kyphoplasty is estimated at less than 2% for osteoporotic VCF and up to 10% for malignant tumor-related VCFs. Surgery is not guaranteed to assist all individuals.
Follow-up care by your doctor is necessary, including:
- Take prescribed medications.
- Icing the area of pain.Heat or ice may be applied after one week depending on what helps the individual feel better.
- Limit activities and lifting heavy objects as prescribed by the doctor.
- Continue medical care under doctor supervision to assist with recovery.