SPINAL CONDITIONS
Vertebral Compression Fractures
A vertebral compression fracture (VCF) occurs when the vertebral body fractures and collapses. These fractures are common. Globally 1.4 million VCFs were diagnosed in 2000, and they affect 40% of women over the age of 80. Vertebral compression fractures are more common than hip fractures. Most VCFs are caused by osteoporosis.
Typically, VCFs present with sudden onset back pain, often without any history of trauma. In addition to pain on movement, patients are often unable to lie flat and many end up sleeping in a chair.
Left alone, many VCFs will heal and the acute pain resolve. However, a number fail to heal. In addition to severe back pain, VCFs can limit your mobility and result in a change to the shape of your spine resulting in you becoming more stooped. This is called a kyphosis. A kyphosis can also cause breathing problems, loss of appetite and sleeping problems. Vertebral compression fractures can significantly interfere with your quality of life.
Investigations
A fracture can be diagnosed on X-ray, though x-ray alone is unable to distinguish between an acute fracture and a chronic, healed fracture. We would normally use an MRI scan to make this distinction. Additionally, you will also require some blood tests to exclude any non-osteoporotic cause of your fracture.
If you are diagnosed with an osteoporotic fracture, then you may need some further investigation of your bone strength if you are not already known to be have osteoporosis. This is called a DEXA scan. If you are found to have osteoporosis, then it is likely that your GP will start you on some medication to try and improve the strength of your bones.
Treatment options
Most of these fractures heal and the pain settles down within six to eight weeks. During this time, you should mobilise as you are able. Many patients will find it helpful to use walking poles when trying to walk. It is likely that you will need to take some regular painkillers. Physiotherapy can help also be helpful.
Hospital admission: Some patients experience such severe pain that they require an acute admission to hospital. On admission you will have your painkillers reviewed and will be seen by a physiotherapist. Occasionally, you may be fitted for a brace.
Cement augmentation (Balloon Kyphoplasty or Vertebroplasty): Injecting cement into the fractured vertebral body stabilises the fracture and gives effective pain relief. We consider this treatment option when VCFs cause pain that necessitates hospital admission, when there is a progressive spinal deformity due to the VCF, or when the pain persists for more than six weeks.
Injections: Some patients present much later on with persisting pain, even though the MRI scan shows the fracture to be healed. The persisting pain can be due to the localized spinal deformity caused by the VCF. This persisting pain is best treated by a combination of physiotherapy and occasionally injections.
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