Vertebral Compression Fractures (VCFs)

Fractures, plastering, and fixing have been part of the transition for many of us from childhood to adulthood. Similarly, vertebral compression fractures are fractures of the vertebrae or bones in the spine. Compression is a reduction in volume due to an increase in pressure. This compression of the spine causes small breaks or cracks in the vertebrae. The weakening of bones, trauma, tumours, and other injuries are the primary causes of fractures.

Vertebral compression fractures (VCFs) can affect any part of the spine; however, they usually affect the thoracic spine (mid-spine). The fracture can cause the spine to weaken and collapse and affect posture over time. Vertebral compression fractures can cause mild to severe symptoms such as muscle weakness, difficulty standing or walking, and sudden back pain that worsens with movement. Another obvious sign could be a gradual decrease in height due to the fractured bones collapsing.

Vertebral compression fractures are a significant health concern, particularly among older adults as they impact the physical health and quality of life. The key reasons why VCFs are a significant health concern:

Prevancace in Older Adults: Osteoporosis is a leading cause of VCFs, and its prevalence increases with age.

Pain and Disability: Severe back pain that interferes with everyday activities can be caused by a vertebral compression fracture.

Spinal Deformity: Repeated fractures can result in kyphosis (hunchback posture), alters body mechanism, etc.

Increased Risk of Future Fractures: A single vertebral compression fracture raises the risk of subsequent fractures due to the weakening of adjacent vertebrae.

Addressing vertebral compression fractures positively and proactively can help older adults maintain their independence, lower complications and improve their overall quality of life.

Types of Vertebral Compression Fracture

The type of vertebral compression fractures can be characterised by the mechanism of injury and stability. There are three main types of vertebral compression fractures based on the mechanism of injury, including:

Wedge Fracture
This type of fracture is the most common and fracture appears on the front part of the vertebrae. The fracture causes the front part of the vertebrae to collapse creating a wedge shape. Wedge fractures are caused by weakening of bones, minor trauma, or osteoporosis.

Burst Fracture

Burst fractures require immediate medical attention as the vertebra collapses in multiple directions, leading to fragments spreading outward. This may compress spinal nerves or the spinal cord leading to neurological symptoms. Such fractures are linked to high-impact trauma like car accidents, falls from height, etc.

Crush Fracture
In this type of fracture the entire vertebrae collapses, not just one side. This type of fracture is associated with severe osteoporosis or metastatic cancer of the spine. 

Vertebral Compression Fracture based on Stability:

Stable Fracture

A condition when the fractured bone does not move out/shift out of place and does not affect nerve or spinal alignment. Stable fractures can be managed with conservative treatment approaches like using a brace and taking adequate rest.

Unstable Fracture

The fractured bone pieces move out of place and start to disrupt spinal stability and may cause spinal deformity or nerve damage. Surgical intervention may be necessary for the treatment of unstable fractures.

Causes of Vertebral Compression Fracture

Vertebral compression fracture may be caused by weakening of the vertebrae or conditions leading to excessive stress on the vertebrae. Some of the common causes leading to vertebral fracture include:

• Injury/Trauma: Severe injury due to high-impact trauma like a car accident or falls may lead to a vertebral compression fracture.
• Osteoporosis: This is the main cause leading to vertebral compression fractures. Osteoporosis reduces bone density making vertebrae more prone to collapse even under minimal stress, like sneezing, coughing, twisting, etc.
• Degenerative Changes: As we age, various spinal disorders usually occur with natural wear & tear of the spinal disc, leading to increased stress on the vertebrae, potentially contributing to fractures over time.
• Cancer: Growth of abnormal malignant tumours in the spine can weaken the vertebrae and lead to stress resulting in fractures.
• Lifestyle Factors: Several lifestyle factors such as a poor diet low in calcium and vitamin D, a sedentary lifestyle, smoking, and excessive alcohol consumption can increase the risk of fracture by reducing bone strength.

Symptoms of a Vertebral Compression Fracture

The severity, type, number of impacted vertebrae, impact on nerves, and spinal cord all affect the symptoms of a vertebral compression fracture. Typical symptoms include the following.

Symptom	Description
Pain	Sudden, severe back pain; worsens with movement
Height Loss	Noticeable reduction in height over time, due to multiple fractures
Spinal Deformity	Forward rounding of the back (kyphosis) causing a hunched posture
Limited Mobility	Difficulty bending, twisting, or performing daily activities
Nerve-Related Symptoms	Numbness, tingling, weakness, or pain if nerves are compressed

Diagnosing Vertebral Compression Fractures

A spine specialist can diagnose vertebral compression fractures by performing a physical examination. The specialist might inquire about numbness, pain locations and other symptoms.

The specialist can further assess for:

Spine’s alignment: Identify postural changes, height loss, hunched posture etc.

Determine pain: Determine the degree of pain in the impacted area in response to touch.

Check for nerve damage: To evaluate nerve compression and monitor nerve response.

Following a physical examination the specialist may recommend specific imaging tests to assess the spine’s alignment, muscles, bones, etc. Some of the frequently used imaging tests include,

• Spine X-ray: Provides a basic view of the spine to help identify fractures & other injuries.
• CT Scan: Helps create 2D images of the spine & provides a detailed view.
• MRI: Gives a detailed image of the soft tissues, disc, ligaments, nerves, etc. 
• Three Phase Bone Scan: To compare and identify the changes taken in three sets of pictures.

Treatment Options for Vertebral Compression Fractures

Treatment for vertebral compression fractures depends on the type of fracture and the severity of the symptoms. The treatment focuses on relieving pain, stabilizing the spine, and preventing another fracture. Some of the common treatment options include,

• Medications: This type of treatment may involve using prescribed medicines and muscle relaxants can help reduce pain and discomfort.

• Braces: Braces can help support the vertebrae and provide support and stability to the spine. Braces can help reduce pain and maintain the posture right.

• Supplements: Using supplements that help increase bone strength like calcium and vitamin D supplements are essential for bone health, additionally medications that help prevent further bone loss can help the conditioning from worsening.

• Physical Therapy: A therapist can guide on stretching & exercises that help strengthen & support muscles and improve mobility.

• Lifestyle Modification: Making certain lifestyle changes can help reduce the risk of further bone weakening, including adding nutrient-rich food to the diet, avoiding smoking & alcohol consumption, etc.

• Surgery: Minimally invasive procedures (Vertebroplasty, Kyphoplasty) are recommended for cases where conservative treatment options are ineffective. These procedures can help stabilise the spine & restore height.

Complications of Untreated Vertebral Compression Fractures

An untreated vertebral compression fracture can cause various issues including,

Chronic Pain: Ongoing back pain that worsens with movement or activity.

Spinal Deformity: Untreated VCFs can cause curvature of the spine affecting posture & mobility.

Increased Risk of Further Fractures: Untreated VCFs can cause repeated fractures, leading to a cycle of worsening fractures.

Neurological Problems: The fractured bone pieces can cause nerve compression or spinal cord injury leading to numbness, weakness, etc.

An untreated vertebral compression fracture can cause chronic pain, mobility limitation, and emotional distress leading to isolation & depression affecting the quality of life.

Measures to Minimize the Risk of Vertebral Compression Fractures