Overview
Your spine (the backbone) consists of individual bones called vertebrae. Fractures in the spine most commonly occur in the middle and lower back, however, they may be seen higher up too.
These fractures may be caused due to a traumatic event, osteoporosis, tumours, or other underlying medical conditions which weaken the bones in the back.
Osteoporosis is a leading cause of vertebral fractures. Osteoporosis is the weakening of the bone due to a lack of vitamin D and calcium, most often seen in menopausal women and elderly people of both sexes. Osteoporosis causes bones to become brittle and prone to fractures after injuries like falls during winter or slipping spontaneously during routine activity. These fractures most often are along the mid to low spine.
The second common cause of fractures is trauma, either after a fall from height, car crashes, sports accidents, or violent acts like gunshots or physical fights. These fractures can be seen anywhere along the whole back from the neck all the way down your spine. These kinds of fractures may be associated with spinal cord injury (transient or permanent) which can affect the functioning of nerves distal to the trauma.
Vertebral fractures may be caused by the spread of cancer to these bones. These kinds of fractures are caused by the tumour eating into the bone and destroying the bone structure. Depending on which area of the bone is involved, the spinal cord might become compressed.
Fractures are classified based on the pattern of injury, which helps determine the proper treatment.
Symptoms
If you have a vertebral fracture, the primary symptom you will experience is moderate to severe back pain that is made worse by movement. This might be difficult to treat with most medications. This affects quality of life considerably. If the fracture affects your spinal cord (traumatic fractures, mostly), you may experience numbness, tingling, weakness, bowel or bladder dysfunction, and shock in the affected area. Depending on the type of fracture and if it causes compression of the spinal cord, the above-listed symptoms may develop. The symptoms depend on the region where the spinal cord is compressed or damaged. These symptoms may be temporary or permanent, depending on the type and duration of injury to the spinal cord.
Diagnosis
Your doctor will diagnose you based on a full physical examination, including laboratory tests, imaging (X-rays, CT scan and MRI) and testing your reflexes.
If you are a post-menopausal woman with severe back aches or an elderly person with back aches either spontaneously or after a fall, your physician will likely get a laboratory investigation (to look for osteoporosis) with or without a bone densitometry.
If the fracture is a result of major trauma, you will need repeated blood tests to check blood circulation. If you have metastatic bone disease, you will need a calcium test to check the level of calcium in your blood.
Imaging techniques are useful for diagnosis. Plain radiographs can be used to screen for spinal fractures. It is sometimes difficult to detect hairline fractures and non-displaced fractures (meaning pieces of the fractured bone are still aligned) using spinal X-rays alone, so CT can be used to detect vertebral fractures and assess the extent of the fractures.
MRI is usually the method of choice for determining the extent of damage to the spinal cord and if the bone there is bone swelling (oedema, in medical terms) or inflamed. In patients with fractures due to trauma or cancer spread, MRI helps see if there is an injury to the spinal cord or if cancer has spread there too. MRI is the most sensitive tool for detecting disease in bones and the spinal cord. It is a very sensitive tool to identify which bones need to be treated. Sometimes, swelling in the bone marrow means the adjacent bone will also need treatment.
Treatment
If you have a minor vertebral fracture, you may be treated non-surgically, such as with a spinal orthotic vest, which is a firm vest that can be worn to stabilise the spine.
The treatment plan for vertebral fractures depends on what is causing it and what the symptoms are.
Conservative medical treatment
This is offered when the pain is limited and can be managed with oral medication. It involves painkillers, a vest or a corset made to size to support the spine, and bed rest. If the fracture is due to osteoporosis, your physician will probably treat osteoporosis too.
Minimally invasive therapy
These procedures may be performed under local anaesthesia with or without conscious sedation, or under general anaesthesia. You will be placed on your abdomen on the X-ray table. Under sterile conditions and imaging guidance, needles will be inserted into the bone in the back to inject stabilizing cement. This is called vertebroplasty. A vertebroplasty may take about 45 mins to 90 minutes depending on the region. On average, up to six fractures may be treated at one time
Another minimally invasive treatment that may be offered is kyphoplasty. In this kind of treatment, balloons are inserted in the bones before the injection of cement to restore the bone height lost due to fracture.
The third minimally invasive treatment that may be offered is vertebral stenting. In this procedure, the doctor will use the needles to insert metallic stents (hollow tubes) in the bone to regain and maintain height, and then cement will be injected in the stent at the end of the procedure. This is offered in young patients with traumatic fractures and height loss.
Surgical procedures
If you have a major or unstable fracture, or your spinal cord is affected, you will need surgical treatment and stabilisation of your spine to prevent spinal deformity. You may also need to have steroids administered intravenously, depending on the nature of the fracture.
What should I expect afterwards?
Normally, 70% of patients feel pain relief and can start moving again within six hours of the procedure.
About 20-25 % experience pain relief in the next week or two. There is, however, a small percentage of people who feel partial or no pain relief.
If osteoporosis is the cause of the fracture, you would be advised to take treatment to correct the underlying condition.
Similarly, for cancer-related fractures, you might need additional anticancer treatment.