What are Vertebral Compression Fractures?

Vertebral compression fractures are fractures in the bones of the spine, called vertebrae, where part of the vertebral body collapses or loses height. These fractures most often affect the thoracic spine or lumbar spine, but they can occur at other spinal levels.

A compression fracture may create a wedge-shaped vertebra, cause sudden back pain, reduce spinal height, or contribute to forward spinal curvature called kyphosis. Some compression fractures are mild and stable, while others may involve spinal instability, nerve compression, spinal cord compression, or an underlying condition such as osteoporosis, trauma, or cancer.

De Novo Brain & Spine evaluates adult patients with suspected or confirmed vertebral compression fractures when symptoms suggest persistent pain, spinal deformity, instability, neurological symptoms, traumatic fracture, osteoporotic fracture, pathologic fracture, or another spine-related condition that may require neurosurgical review.

Common Signs and Symptoms

Vertebral compression fracture symptoms depend on the fracture location, severity of collapse, cause of the fracture, spinal alignment, and whether nerves or the spinal cord are affected.

Common signs and symptoms may include:

• Sudden back pain
• Mid back pain or low back pain
• Pain that worsens with standing, walking, bending, lifting, or twisting
• Pain that improves when lying down in some patients
• Tenderness over the affected spinal level
• Reduced spinal mobility
• Muscle spasms or stiffness
• Loss of height over time
• Rounded or forward-bent posture
• Kyphosis, sometimes described as a hunched posture
• Difficulty standing upright
• Pain after a fall, lifting injury, or minor trauma
• Pain after minimal activity in patients with osteoporosis
• Numbness, tingling, weakness, or walking difficulty if nerve or spinal cord compression is present
• Bowel or bladder changes in severe cases involving nerve compression

Seek urgent medical evaluation for back pain after trauma, severe or worsening pain, progressive weakness, numbness, trouble walking, loss of coordination, numbness in the groin or saddle area, new bowel or bladder problems, fever, unexplained weight loss, history of cancer, or rapidly worsening neurological symptoms. Seek emergency medical care or call 911 for symptoms concerning for cauda equina syndrome, spinal cord compression, stroke, or another emergency condition.

What Causes This Condition?

A vertebral compression fracture occurs when a vertebral body cannot withstand the force placed on it and collapses. The cause may be bone weakness, trauma, tumor, or another condition affecting spinal strength.

Possible causes and related factors may include:

• Osteoporosis, a condition that weakens bones and increases fracture risk
• Osteopenia, or low bone density
• Falls or direct trauma
• Motor vehicle accidents
• Sports injury or work-related injury
• Lifting, bending, coughing, sneezing, or minor stress in patients with severe osteoporosis
• Long-term corticosteroid use, which may weaken bone in some patients
• Advanced age and reduced bone strength
• Prior vertebral compression fracture
• Cancer involving the spine, including metastatic disease
• Multiple myeloma or other bone-affecting conditions
• Infection or inflammatory disease in selected cases
• Metabolic bone disease in selected patients
• Spinal deformity, such as kyphosis or scoliosis, that changes spinal loading

These causes and risk factors do not mean every patient has the same type of fracture. Treatment planning depends on the cause of the fracture, fracture age, spinal stability, pain severity, neurological examination, bone health, imaging findings, and overall health.

How It Is Diagnosed?

Vertebral compression fractures are diagnosed through medical history, physical examination, neurological examination, and imaging. Testing helps determine whether the fracture is new or old, stable or unstable, osteoporotic, traumatic, or related to another condition.

Common diagnostic steps may include:

• Medical history and symptom review to understand pain onset, injury history, osteoporosis history, cancer history, medication use, prior fractures, and red-flag symptoms
• Physical examination to evaluate posture, tenderness, range of motion, muscle spasm, painful movement, and walking pattern
• Neurological examination to assess strength, sensation, reflexes, coordination, gait, balance, and signs of nerve root or spinal cord involvement
• X-rays of the spine to evaluate vertebral height loss, wedge deformity, kyphosis, alignment, and other fractures
• MRI of the spine to help determine whether a fracture is acute, subacute, or chronic and to evaluate nerve compression, spinal cord compression, tumor, infection, or soft-tissue findings
• CT scan to evaluate bone detail, fracture pattern, spinal canal involvement, posterior wall involvement, or surgical planning
• Bone density testing, also called DEXA scan, when osteoporosis or low bone density is suspected
• Blood tests in selected cases when infection, inflammation, metabolic bone disease, multiple myeloma, or cancer-related concern is suspected
• Biopsy in selected cases when imaging or history raises concern for tumor, infection, or another pathologic cause
• Standing spine X-rays in selected cases to evaluate kyphosis, spinal alignment, or overall posture
• CT myelogram in selected cases when MRI is not possible or when additional detail around the spinal canal and nerve structures is needed

The goal of diagnosis is to confirm the fracture, identify the cause, evaluate spinal stability, determine whether nerves or the spinal cord are affected, and decide whether conservative care, fracture treatment, or surgical evaluation may be appropriate.

Treatment Options

Vertebral compression fracture treatment depends on the cause of the fracture, pain severity, fracture age, spinal stability, neurological examination, imaging findings, degree of vertebral collapse, bone health, activity limitations, and overall health. Not every compression fracture requires surgery.

Treatment options may include:

• Observation and follow-up imaging for selected stable fractures with mild symptoms
• Activity modification to avoid lifting, bending, twisting, or movements that worsen pain during healing
• Pain medication when medically appropriate
• Anti-inflammatory medication or acetaminophen when appropriate based on medical history
• Bracing in selected cases to support the spine during healing
• Physical therapy after the appropriate healing period to improve posture, strength, mobility, balance, and safe movement mechanics
• Fall prevention strategies to reduce the risk of additional fractures
• Osteoporosis evaluation and treatment when low bone density is present or suspected
• Calcium, vitamin D, or bone-strengthening medication when recommended by the treating medical team
• Kyphoplasty in selected painful compression fractures when symptoms, imaging, and clinical findings support vertebral augmentation
• Vertebroplasty in selected cases when appropriate after careful review of risks, benefits, and alternatives
• Treatment of an underlying tumor, infection, or metabolic bone disease when one is identified
• Spinal decompression in selected cases when nerve or spinal cord compression is present
• Spinal fusion or stabilization in selected cases involving instability, progressive deformity, burst fracture features, neurologic compromise, or structural failure
• Rehabilitation and follow-up care to monitor pain, posture, walking, strength, bone health, and fracture healing

Surgery is not appropriate for every vertebral compression fracture. Neurosurgical treatment may be considered when a fracture causes persistent severe pain, progressive collapse, spinal instability, neurological symptoms, spinal cord compression, deformity, or when the fracture is related to tumor, infection, or significant trauma.