A compression fracture is a collapse of a
vertebra
The spinal column, a defining synapomorphy shared by nearly all vertebrates, Hagfish are believed to have secondarily lost their spinal column is a moderately flexible series of vertebrae (singular vertebra), each constituting a characterist ...
. It may be due to trauma or due to a weakening of the vertebra (compare with
burst fracture). This weakening is seen in patients with
osteoporosis or
osteogenesis imperfecta
Osteogenesis imperfecta (; OI), colloquially known as brittle bone disease, is a group of genetic disorders that all result in bones that break easily. The range of symptoms—on the skeleton as well as on the body's other organs—may b ...
,
lytic
The lytic cycle ( ) is one of the two cycles of viral reproduction (referring to bacterial viruses or bacteriophages), the other being the lysogenic cycle. The lytic cycle results in the destruction of the infected cell and its membrane. Bacteri ...
lesions from
metastatic
Metastasis is a pathogenic agent's spread from an initial or primary site to a different or secondary site within the host's body; the term is typically used when referring to metastasis by a cancerous tumor. The newly pathological sites, then, ...
or
primary tumor A primary tumor is a tumor growing at the anatomical site where tumor progression began and proceeded to yield a cancerous mass. Most cancers develop at their primary site but then go on to metastasize or spread to other parts of the body. These fur ...
s, or infection. In healthy patients, it is most often seen in individuals suffering extreme vertical shocks, such as ejecting from an
ejection seat
In aircraft, an ejection seat or ejector seat is a system designed to rescue the pilot or other crew of an aircraft (usually military) in an emergency. In most designs, the seat is propelled out of the aircraft by an explosive charge or rocke ...
. Seen in lateral views in plain
x-ray
X-rays (or rarely, ''X-radiation'') are a form of high-energy electromagnetic radiation. In many languages, it is referred to as Röntgen radiation, after the German scientist Wilhelm Conrad Röntgen, who discovered it in 1895 and named it ' ...
films, compression fractures of the spine characteristically appear as ''wedge deformities'', with greater loss of height anteriorly than posteriorly and intact
pedicles in the anteroposterior view.
Signs and symptoms
Acute fractures will cause severe
back pain
Back pain is pain
Pain is a distressing feeling often caused by intense or damaging stimuli. The International Association for the Study of Pain defines pain as "an unpleasant sensory and emotional experience associated with, or resembling ...
. Compression fractures which develop gradually, such as in osteoporosis, may initially not cause any symptoms, but will later often lead to back pain and loss of height.
Diagnosis
Compression fractures are usually diagnosed on
spinal radiographs, where a wedge-shaped vertebra may be visible or there may be loss of height of the vertebra. In addition,
bone density measurement may be performed to evaluate for osteoporosis. When a tumor is suspected as the underlying cause, or the fracture was caused by severe trauma,
CT or
MRI scans may be performed.
L4 compressionFracture2008.jpg, Compression fracture of the fourth lumbar vertebra post falling from a height.
Compressionfracture.jpg, X-ray of the lumbar spine with a compression fracture of the third lumbar vertebra.
File:T12compressionfracMark.png, Compression fracture of T12
Treatment
Conservative treatment
*
Back brace
A back brace is a device designed to limit the motion of the spine in cases of bone fracture or in post-operative spinal fusiona, as well as a preventative measure against some progressive conditions or to correct patient posture.
Common back ...
for support while the bone heals—either a Jewett brace for relatively stable and mild injuries, or a
thoracic lumbar sacral orthosis (TLSO) for more severe ones.
*
Opioids
Opioids are substances that act on opioid receptors to produce morphine-like effects. Medically they are primarily used for pain relief, including anesthesia. Other medical uses include suppression of diarrhea, replacement therapy for opioid us ...
or
non-steroidal anti-inflammatory drug
Non-steroidal anti-inflammatory drugs (NSAID) are members of a therapeutic drug class which reduces pain, decreases inflammation, decreases fever, and prevents blood clots. Side effects depend on the specific drug, its dose and duration of ...
s (NSAIDs) for pain. For
osteoporotic patients,
calcitonin
Calcitonin is a 32 amino acid peptide hormone secreted by parafollicular cells (also known as C cells) of the thyroid (or endostyle) in humans and other chordates. in the ultimopharyngeal body. It acts to reduce blood calcium (Ca2+), opposing ...
may be helpful.
Surgical
*
Kyphoplasty and
vertebroplasty are minimally invasive procedures that inject cement into the bone of the back that is fractured. However, the data examining the effectiveness of these procedures is mixed.
References
Further reading
*
Medscape article on lytic lesionsEmedicine article on spinal metastasis
External links
{{Authority control
Bone fractures
Orthopedic problems