Vertebral Fractures

What is a vertebral fracture?

Also called a spinal fracture, it is a broken spinal vertebra. Most fractures occur in the midback or lumbar spine and vary widely in their severity and the risk of serious spinal cord and nerve injury. Treatment depends on the cause, fracture severity and the presence of other related injuries. The majority of vertebral fractures are treated with bracing and pain medication.

What causes a vertebral fracture?

Most vertebral fractures are the result of osteoporosis. However, other factors that can weaken bones include trauma, cancer, chemotherapy, infection, long-term steroid use, hyperthyroidism, and radiation therapy. Trauma is the second most common cause of a spine fracture. Auto accidents are the number one cause of spinal cord injury but falls and gunshot wounds rank high.

What is osteoporosis?

Osteoporosis is a disease of the elderly where the bones become brittle and are easily broken with minor trauma. In people with osteoporosis even simple activities like lifting a light object, sneezing, coughing, or slipping in the shower can cause a compression fracture. Osteoporosis can result in painful compression fractures of the vertebrae.

Who is at risk for an osteoporotic vertebral fracture?

Osteoporotic vertebral fractures affect about 30% of postmenopausal women in the United States; and 20% of men over the age of 50. Studies report that an initial vertebral compression fracture is associated with a 5-fold elevated risk of subsequent vertebral compression fractures and a doubling in the risk of hip fractures.

What are the types of vertebral fractures?

• A compression fracture occurs when the spine collapses due to weak bones causing small breaks or cracks in the vertebrae. Vertebral compression fractures can be debilitatingly painful or asymptomatic. These fractures rarely cause impingement on the spinal cord or nerve roots but can causes deformity and loss of height. They may be treated with conservative management or surgery.
• A burst fracture is usually caused by high energy trauma and requires emergency treatment because bone fragments can injure the spinal cord or nerves. However, a burst fracture can occur with minor trauma in the patient with osteoporosis or a tumor. Stability of the fracture determines whether surgery is necessary. Symptoms include moderate to severe pain, numbness, and tingling that worsens with movement, bowel and bladder problems, and paralysis.

How is a vertebral fracture diagnosed?

Dr. Federico Girardi specializes in the diagnosis and treatment of spinal disorders including fractures of the spine. He will review your medical history, ask about your symptoms, and conduct a thorough physical exam, including testing for neurological problems such as reduced leg strength, weakness, paralysis, loss of sensation and urinary and fecal incontinence. Imaging studies are the gold standard for diagnosing and assessing spinal fractures.

All patients with a suspected vertebral fracture including elderly patients and patients at risk for osteoporosis will receive spinal x-rays and a CT scan to evaluate the spine for fractures.

Patients who experience acute back pain after a low energy trauma or ground level fall will be evaluated for a compression fracture and undergo diagnosis osteoporosis. Osteoporosis can be diagnosed with a diagnosis of a compression fracture, and/or with a DEXA scan. Burst fractures of the midback and lumbar spine are evaluated with a CT scan. An MRI may be needed to evaluate soft tissues.

How is a compression fracture treated?

The goal of treatment is to ensure spinal stability and to preserve function. Minor fractures of the midback and lumbar spine are usually stable and do not require intervention when there are no related neurological problems. These can be treated with conservative management to reduce pain and improve function and include bracing for up to 12 weeks and pain management. After the bone has healed a rehabilitation program for 3-6 months will help to restore function and strength and reduce pain and disability. However, when pain persists after a trial of conservative therapy, surgery may be recommended.

When neurologic problems and/or instability occur surgery may be necessary. The focus of surgery is to stabilize the vertebrae and decompress the spinal nerves. Two procedures that may be recommended to reduce pain and improve quality of life are Kyphoplasty and Vertebroplasty. In addition, osteoporosis, should be treated to reduce the risk of future spinal and associated fractures.

What is the treatment for traumatic and serious spinal fractures?

Unstable spinal fractures create a significant risk of serious spinal cord injury and will require surgery with decompression of the nerve or spinal canal and stabilization of the spine.

Contact Dr. Girardi at the Hospital for Special Surgery (HSS) in Manhattan to schedule a consultation. He is internationally renowned and always treats his patient with compassion and respect.