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Wednesday, August 20, 2014

What is a Vertebral Compression Fracture?

A Vertebral Compression Fracture (VCF) is a collapse of a vertebra in the spine. Typically, the main body of the vertebra collapses, rather than other, smaller parts of a vertebra. Since the collapse of the vertebra is in the front portion of the vertebra, the spine often begins to curve forward.

Why do patients get a Vertebral Compression Fracture?
VCF’s are caused by too much pressure on the front of the vertebrae, which is the vertebral body. This happens when the spine is bent forward (flexed) too far, or too much weight is placed on the spine. This  causes the vertebral body to collapse in a wedge or "pie" shape (smaller in front than back).
Less common is a burst fracture, where the vertebrae breaks off into pieces, some of which could cause compression of the spinal cord or spinal nerves. While osteoporosis (bone thinning) related VCF’s are the most common, they can also occur due to trauma or bone cancer.
Here are some of the common causes of Vertebral Compression Fractures:
1.     Motor Vehicle Accidents
2.     Sports Accidents
                         3.   Osteoporosis or Spine Cancer related, caused by:
                   a. A strong cough or sneeze
                   b. Bending forward
                   c. Lifting something heavier
                   d. Fall

How common are Vertebral Compression Fractures (VCF)?
It is estimated that 700,000 VCF’s occur each year in the U.S.. Studies have shown that up to 15% of women and 5-9% of men will have a VCF in their life time. 40% of women over the age of 80 will have a VCF. After having a VCF, the risk of having another one is 20% in the first year in women after menopause. 
Where in the spine do Vertebral Compression Fractures usually occur?
VCF’s most commonly occur in the mid-back (thoracic spine), and low-back (lumbar spine).The most common spinal levels affected are T7, T8, T12 and L1.
How long do Vertebral Compression Fractures take to heal?
This depends on the reason for the fracture. Fractures related to trauma and osteoporosis tend to heal within 6-8 weeks. Fractures related to cancer may not heal completely.
What are the common symptoms from a Vertebral Compression Fracture?
VCF’s may not cause symptoms. Here are some common symptoms for the ones which do:
1.     Sudden spine pain in the middle of the spine
2.     Pain in the spine worsened when bending forward or down
3.     Worsened pain with standing, sitting or walking, improved when lying down.
4.     Muscle spasms on the sides of the spine
5.     Developing a “hump” in the back over time
6.     Loss of body height over time
7.     Pain spreading up and down the spine
8.     Pain, numbness and weakness in the legs (burst fractures)

How are Vertebral Compression Fractures diagnosed?
It is estimated that only 1/3rd of VCF’s are diagnosed. Part of the reason is that many VCF’s can cause very little or no pain at all.
1.     History
A history of a sudden onset of back pain especially in patient with known or suspected Osteoporosis can be a tip off for a VCF.
            2. Physical Examination
Here are some examinations the doctor may perform to help diagnose a VCF:
a. Inspection of the spine looking for a “humpback” deformity
b. Pushing and touching the spine (palpation) looking for pain, swelling and deformity
c. Mobility testing (range of motion)
d. Sensory (sensation) testing in the legs
e. Muscle strength (motor) testing in the legs
f. Reflex testing in the legs 
          3. Imaging Tests
a. X-Ray

X-Rays of the spine can show the common “wedge fractures” seen in VCFs. Here is a Color X-Ray showing a mid-back (thoracic) VCF. This Image is Interactive. Just move your mouse cursor over the Image to learn more (if the interactive tags do not load properly due to low browser speeds just refresh the page).          
lateral color x-ray thoracic compression fracture, VCF
Interactive Color X-Ray of a Compression Fracture in the mid-back (thoracic spine)

b. CT Scan
CT Scans can show more details of a VCF and its potential impact on other structures. However, 
the radiation does from CT scans high. Here is a Color CT Scan which is also Interactive.          

Sagittal Color CT thoracic compression fracture
Interactive Color CT Scan showing a mid-back (thoracic) compression fracture
c. MRI Scans
MRI scans can show compression fractures. While MRI technology is not as good as a CT scan to show specific details of the vertebral bones, it is an excellent tool to see swelling inside a vertebrae from a VCF, and a potential compression of the spinal cord and spinal nerves. Here is a color MRI of a mid-back (thoracic) VCF:

Sagittal Color MRI thoracic compression fracture, VCF
Interactive Color MRI of a mid-back (thoracic spine) Compression Fracture

d. Nuclear Bone Scans
Nuclear bone scans show the activity in a VCF which is created by the body’s attempt to heal it. It can be very specific for a VCF and show where in the spine it is located. However it cannot show any details about the fracture or the other structures which could be affected by it.

How are Compression Fractures treated?

1.     Non-Surgical Treatments
Here are some common non-surgical treatments available:
A. Alternative Health Care
Alternative health options can complement traditional medicine. Massage Therapy, Acupuncture, Meditation exercises and Herbal Remedies can all help with the pain from compression fractures.
B. Chiropractic Care
Chiropractic care in the form of manipulation is generally not advisable for a compression fracture of the spine.
C. Spine Exercises
Spine exercises are generally not recommended for a recent compression fracture. Once the fracture is healed, gentle spine exercises can help with some of the residual muscle pain.
D. Activity Restriction
Typically it is recommended to limit bending, twisting, lifting, and any other higher impact activity such as running.
E. Physical Therapy (PT)
Some gentle PT interventions such as Ultrasound Treatments can alleviate some of the muscle pain from a VCF. PT can help mobilize patients who are suffering from the pain related to a VCF.
F. Self Help Devices
Back Braces can help with the pain from the fracture and provide some stability while the fracture heals. A spine surgeon can recommend the proper brace if it is advisable.
G. Medications
Here are some of medications which can help relieve pain from VCFs.
1.     Non-Steroidal Anti-Inflammatory Drugs (NSAIDS)
2.     Muscle Relaxants
3.     Pain Killers
H. Injections
Here are some Injections which can help the pain from VCFs:
1.     Trigger Point Injections
2.     Muscle Blocks
3.     Interlaminar Epidural Steroid Injections

I. Minimally Invasive Treatments
Minimally invasive treatment options such as a Vertebroplasty or Kyphoplasty can help with the pain and instability of the vertebra from VCF’s. Here is a Color MRI of a Kyphoplasty. This Image is Interactive.

Sagittal Color MRI Kyphoplasty Lumbar
Interactive Color MRI of a Kyphoplasty Procedure
Here is another Color MRI which shows how a VCF can be restored. Notice how the balloon lifts the fracture:

Sagittal Color MRI Vertebral Compression Fracture Kyphoplasty
Color MRI showing how a VCF is restored by Kyphoplasty

             2. Surgical Treatments
Surgical treatments for VCFs are generally only recommended for those resulting from trauma or cancer. An exception would be a complicated VCF related to Osteoporosis (burst fracture) which is creating pressure on the spinal cord or spinal nerves.
Here are some surgeries which can be done for complicated or unstable VCFs:
Thoracic Vertebrectomy
Thoracic Laminectomy and Fusion
Thoracic Fusion with Instrumentation



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