vertebral compression fracture

{{Short description|Breakage of a spinal vertebra under vertical pressure}}

{{Infobox medical condition (new)

| name = Compression fracture

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| image = Blausen 0250 CompressionFracture Vertebrae.png

| caption = Example of vertebral compression fracture.

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| field = orthopedic

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A compression fracture is a collapse of a vertebra. 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, lytic lesions from metastatic or primary tumors,{{cite web |first=Kristy |last=Weber |date=February 28, 2006 |url=http://www.hopkins-arthritis.org/physician-corner/cme/rheumatology-rounds/metastatic_bone_disease_rheumrounds2.html |title=Rounds 2: Treatment of Metastatic Bone Disease |publisher=Johns Hopkins Arthritis Center}} or infection.{{cite web |url=https://www.nlm.nih.gov/medlineplus/boneinfections.html |title=Bone Infections |date=September 7, 2011 |publisher=MedlinePlus}} In healthy patients, it is most often seen in individuals suffering extreme vertical shocks, such as ejecting from an ejection seat. Seen in lateral views in plain x-ray 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.{{cite book |last1=Brant |first1=William E. |last2=Helms |first2=Clyde A. |year=2007 |chapter=Benign Compression Fracture |chapter-url=https://books.google.com/books?id=Sossht2t5XwC&pg=PA302 |title=Fundamentals of Diagnostic Radiology |edition=3rd |page=302 |publisher=Lippincott Williams & Wilkins |location=Philadelphia |isbn=978-0-7817-6135-2}}

Signs and symptoms

Acute fractures will cause severe back pain. 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.{{citation needed|date=October 2020}}

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.{{citation needed|date=October 2020}}

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

File:Intravertebral vacuum cleft sign.jpg of the vertebral body, which is called Kümmel's disease, and may appear with the intravertebral vacuum cleft sign (at white arrow in image).{{cite journal|last1=Freedman|first1=B. A.|last2=Heller|first2=J. G.|title=Kummel Disease: A Not-So-Rare Complication of Osteoporotic Vertebral Compression Fractures|journal=The Journal of the American Board of Family Medicine|volume=22|issue=1|year=2009|pages=75–78|issn=1557-2625|doi=10.3122/jabfm.2009.01.080100|pmid=19124637|doi-access=free}}]]

=Conservative treatment=

Back brace 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.{{cite web|url=http://www.oandp.com/oandp-l/message.asp?frmMessageId=73C88D08-3753-4A8A-ADF6-144E33E73564 | title=Jewett vs. TLSO Replies | work=OANDP-L on oandp.com | date=2010-09-27 | access-date=2012-09-02 }}
Opioids or non-steroidal anti-inflammatory drugs (NSAIDs) for pain. For osteoporotic patients, calcitonin may be helpful.{{cite web | url=http://www.medicine.ox.ac.uk/bandolier/booth/painpag/Chronrev/muscskel/CP104.html | archive-url=https://www.webarchive.org.uk/wayback/archive/20090608194055/http://www.medicine.ox.ac.uk/bandolier/booth/painpag/Chronrev/muscskel/CP104.html | url-status=dead | archive-date=2009-06-08 | title=Calcitonin for osteoporotic fractures | access-date=2012-09-03 }}{{cite journal |doi=10.1007/s00198-004-1798-8 |title=Calcitonin for treating acute pain of osteoporotic vertebral compression fractures: A systematic review of randomized, controlled trials |year=2004 |last1=Knopp |first1=Jennifer A. |last2=Diner |first2=Barry M. |last3=Blitz |first3=Maurice |last4=Lyritis |first4=George P. |last5=Rowe |first5=Brian H. |journal=Osteoporosis International |volume=16 |issue=10 |pages=1281–90 |pmid=15614441|s2cid=34208503 }}

=Surgical=

Kyphoplasty{{cite journal |doi=10.1097/01.brs.0000244639.71656.7d |title=Balloon Kyphoplasty and Vertebroplasty for Vertebral Compression Fractures |year=2006 |last1=Taylor |first1=Rod S. |last2=Taylor |first2=Rebecca J. |last3=Fritzell |first3=Peter |journal=Spine |volume=31 |issue=23 |pages=2747–55 |pmid=17077747|s2cid=209491 }} and vertebroplasty{{cite journal |doi=10.1007/s00586-007-0308-z |title=Balloon kyphoplasty in the management of vertebral compression fractures: An updated systematic review and meta-analysis |year=2007 |last1=Taylor |first1=Rod S. |last2=Fritzell |first2=Peter |last3=Taylor |first3=Rebecca J. |journal=European Spine Journal |volume=16 |issue=8 |pages=1085–100 |pmid=17277923 |pmc=2200787}} 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.{{cite journal |doi=10.1007/s00198-011-1639-5 |title=Balloon kyphoplasty and vertebroplasty in the management of vertebral compression fractures |year=2011 |last1=Boonen |first1=S. |last2=Wahl |first2=D. A. |last3=Nauroy |first3=L. |last4=Brandi |first4=M. L. |last5=Bouxsein |first5=M. L. |last6=Goldhahn |first6=J. |last7=Lewiecki |first7=E. M. |last8=Lyritis |first8=G. P. |last9=Marsh |first9=D. |last10=Obrant |first10=K. |last11=Silverman |first11=S. |last12=Siris |first12=E. |last13=Åkesson |first13=K. |journal=Osteoporosis International |volume=22 |issue=12 |pages=2915–34 |pmid=21789685|display-authors=8 |author14=CSA Fracture Working Group of International Osteoporosis Foundation |s2cid=19967779 }}{{cite journal |doi=10.1007/s00264-011-1283-x |title=Percutaneous vertebroplasty versus balloon kyphoplasty for treatment of osteoporotic vertebral compression fracture: A meta-analysis of randomised and non-randomised controlled trials |year=2011 |last1=Han |first1=Shiliang |last2=Wan |first2=Shuanglin |last3=Ning |first3=Lei |last4=Tong |first4=Yongjun |last5=Zhang |first5=Jianfeng |last6=Fan |first6=Shunwu |journal=International Orthopaedics |volume=35 |issue=9 |pages=1349–58 |pmid=21637959 |pmc=3167445}}