What is a vertebral compression fracture?

A VCR or vertebral compression fracture is a fracture in the bones of the spine (vertebrae), which occurs when the vertebral body (weight-bearing, block-like part at the front of the spine) becomes compressed or squashed. This is most commonly seen in the lumbar spine (lower spine).

There are three causes of these fractures, which are:

• Osteoporotic: Osteoporosis is a disease of the bone, causing reduced bone density. This may increase the chance of sustaining a vertebral compression fracture without trauma. The risk of osteoporosis and, therefore, vertebral compression fractures increases in women post-menopause.
• Trauma: Usually, the force needed to cause a vertebral compression fracture is relatively high. These often occur as a result of a fall from a height, landing feet first or road traffic accidents.
• Pathological: Fractures occur as a result of pre-existing disease, such as metastatic cancer, but also other conditions, such as osteomyelitis (infection of the bone) or Paget’s disease.

Symptoms include:

• Pain – especially in the lower back.
• Numbness, tingling and weakness – this can occur if the bony fragments from the fracture cause compression of the nerves at the fracture level.
• Incontinence or urinary retention – this can occur if fracture fragments press on the spinal cord.

Diagnosis is via X-ray, CT scan or MRI.

The treatment of a VCR varies depending on the severity and the symptoms. The treatment options start conservatively and progress through to surgery. These include:

• Back brace
• Rest and ice
• Pain relief – including non-steroidal anti-inflammatories, muscle relaxants
• Exercise – when signed off by the doctor to prevent further osteoporosis and strengthen the muscles in the back.

If these conservative treatments do not have the desired effect or the fracture is causing neural problems, there are surgical options.

• Kyphoplasty: A kyphoplasty is a minimally invasive procedure which aims to reduce or stop the pain caused by micro-movement in vertebrae, often linked to a fracture. During a kyphoplasty, the spine is accessed from the back through a small keyhole incision, allowing the surgeon to pass a narrow tube. Positioning of the tube is confirmed and guided by X-ray images. The tube creates a pathway from the skin to the damaged vertebral body via the pedicle (part of the vertebra linking the front to the back). The surgeon inserts a special balloon through the tube into the vertebra and gently inflates it. As the balloon inflates, it compresses the soft bone, creating a void inside the vertebra. It may also partially restore the height of the vertebral body. The surgeon removes the balloon and injects a cement-like material into the void via the tube. The cement-like material (polymethylmethacrylate) hardens quickly once injected to stabilise the bone.
• Vertebroplasty: A vertebroplasty is a minimally invasive procedure which aims to reduce or stop the pain caused by micro-movement in vertebrae, often linked to a fracture. During a vertebroplasty, the spine is accessed from the back through a small keyhole incision, allowing the surgeon to pass a narrow tube. Positioning of the tube is confirmed and guided by X-ray images. The tube creates a pathway from the skin to the damaged vertebral body via the pedicle (part of the vertebra linking the front to the back). The surgeon removes the balloon and injects a cement-like material into the void via the tube. The cement-like material (polymethylmethacrylate) hardens quickly once injected to stabilise the bone.
• Decompression to relieve pressure on the spinal cord by removing some bone from the back of the spine.

Often, VCRs are linked to osteoporosis (brittle bones), and so reducing your risk of osteoporosis will help reduce the fracture risk. It is essential to maintain a balanced diet rich in calcium and vitamin D, and to exercise regularly, particularly weight-bearing exercises, to build bone strength. Quitting smoking will also help to reduce the risk.

This article is intended to inform and give insight, but not treat, diagnose or replace the advice of a doctor. Always consult a doctor for any questions regarding a medical condition.