Mr James Langdon

BSc (Hons) MB BS MRCS (Eng) FRCS (Orth) Consultant Orthopaedic Spinal Surgeon

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 change the shape of your spine. They 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 a MRI scan to make this distinction. Additionally you will also require some blood tests to exclude any non-osteoporotic cause of your fracture.

Treatment options:

Most of these fractures heal and the pain settles down within 6 to 8 weeks. During this time you should mobilize as much as you are able. 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): Injecting cement into the fractured vertebral body stabilizes 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 6-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 facet joint injections.