Thoracic Compression Fractures (2024)

A Patient's Guide to Thoracic Compression Fractures

Introduction

The bones, or vertebrae, that make up your spine are very strong, but sometimesa vertebra can fracture - just like any other bone in your body. Vertebra fracturesare usually due to conditions such as: osteoporosis (a condition which weakensthe bones), a very hard fall, excessive pressure, or some kind of physical injury.

When a bone in the spine collapses, it is called a vertebral compression fracture.These fractures happen most commonly in the thoracic spine (the middle portionof the spine), particularly in the lower vertebra of the thoracic spine.

The purpose of this information is to help you understand:

The anatomy of the spine relating to compression fractures
The causes and symptoms of compression fractures
How the condition is diagnosed
The treatments available for the condition
Some complications associated with compression fractures

Anatomy

To best understand lumbar spine injuries, it helps to know some anatomy of the overall spine.

Please review the document, entitled:

Anatomy and Function of the Spine

Compression fractures of the spine usually occur at the bottom part of thethoracic spine (T11 and T12) and the first vertebra of the lumbar spine (L1).

Compression fractures of the spine generally occur from too much pressure onthe vertebral body. This usually results from a combinationof bending forward and downward pressure on the spine. For example, fallingfrom a chair in a sitting position on the floor usually causes your head togo forward at the same time your buttocks hit the floor. This causes the spineto bend forward concentrating the pressure on the front part of the spine -the vertebral bodies. The fracture occurs when the bone actually collapses andthe front (anterior) part of the vertebral body forms a wedge shape. The cancellousbone on the inside of the vertebral body is crushed, or compressed. In verysevere compression fractures, the back of the vertebral body may actually protrudeinto the spinal canal and put pressure on the spinal cord. Fortunately, thisis not a common occurrence.

Causes

There is not one single cause of compression fractures, though the word compressionwould indicate that the fracture occurs because of too much pressure being placedon the bone. If the bone is too weak to hold normal pressure, it may not takemuch pressure to cause the vertebral body to collapse. Most healthy bones canwithstand a lot of pressure and the spine will bend to absorb the shock. However,if the force is too great for the vertebrae to sustain, one or more of themcan fracture. To understand a fracture, think about bending a pencil. If youplace pressure on the pencil, it will bend a little then go back into placewhen the pressure is gone. However, if you bend the pencil too far - past itsbreaking point, it will crack or break apart. Similarly, the amount a vertebracollapses/fractures depends upon the amount of pressure it has to withstand.

A common cause of compression fractures is the disease osteoporosis. This diseasethins the bones, often to the point that they are too weak to bear normal pressure.The thinning bones can collapse during normal activity, leading to a spinalcompression fracture. In fact, spinal compression fractures are the most commontype of osteoporotic fractures. Forty percent of all women will have at leastone by the time they are 80 years old. These vertebral fractures can permanentlyalter the shape and strength of the spine. The fractures usually heal on theirown and the pain goes away. However, sometimes the pain can persist if the crushedbone fails to heal adequately.

In severe cases of osteoporosis, actions as simple as bending forward can beenough to cause a "crush fracture", or spinal compression fracture. This typeof vertebral fracture causes loss of height and a humped back - especially inelderly women. This disorder (called kyphosis or a "dowager's hump") is an exaggerationof your spine, that causes the shoulders to slump forward and the top of yourback to look enlarged and humped.

Trauma to the spinal vertebrae can also lead to minor or severe fractures.Such trauma could come from a fall, a forceful jump, a car accident, or anyevent that stresses the spine past its breaking point.

Another cause of vertebral fractures is a metastatic disease. Metastasis isa term that refers to the spread of cancer cells into other areas of the body.The bones of the spine are a common place for many types of cancers to spread.A compression fracture of the spine that appears for little or no reason maybe the first indication that an unrecognized cancer has spread to the spine.The cancer causes destruction of part of the vertebra, weakening the bone untilit collapses. This is a sign that something going on internally is harming thebones.

Symptoms

If the fracture is caused by a sudden, forceful injury, you will probably feelsevere pain in your back, legs, and arms. You might also feel weakness or numbnessin these areas if the fracture injures the nerves of the spine. If the bonecollapse is gradual - such as a fracture from bone thinning, the pain will usuallybe milder. There might not be any pain at all until the bone actually breaks.

Diagnosis

In order for a fracture to be diagnosed, you will need to visit a health careprovider. Before your doctor can diagnose your condition and design a treatmentplan, a complete history and physical examination are necessary. There are manypossible internal causes of pain. It is important to determine what is and isnot the root of the problem. After the physician has a better idea of what iscausing your discomfort, diagnostic tests of some sort may be recommended.

History

First, you will be asked for a complete history of your condition. This maybegin by filling out a written form that asks you a number of questions relatingto your pain. The more information you share with your provider, the easieryour problem will be to diagnose. Your history is important because it helpsyour doctor understand: when the pain began, anything that could have causedan injury, physical factors that might be causing the pain, and any family historyof similar problems. After reading through your written history, your physicianwill ask more questions that relate to the information you have given.

Some typical questions include:

When did the pain begin?
Was there an injury that could be related to the pain?
Where do you feel the pain? What is the intensity?
Does the pain radiate to other parts of the body?
What factors make the pain feel better or worse?
Have you had problems with your bladder or bowels?
Is there a history of osteoporosis in your family?

Physical Examination

After taking your history, the physician will give you a physical examination.This allows the doctor to rule out possible causes of pain and to try to determinewhat is causing your problems. The areas of your body that will be examineddepend upon where you are experiencing pain - neck, lower back, arms, legs,etc. Neurological problems are rare except in younger patients who have experienceda violent injury, such as a car crash.

If a compression fracture is suspected, the doctor will also test for pointtenderness near specific vertebrae. Testing specific areas for unusual tendernessallows the doctor to narrow down the cause of your pain.

If a fracture is thought to exist, an X-ray of the spine will generally confirmits presence. An X-ray is a painless process that uses radioactive materialsto take pictures of bone. X-rays show bones, but not much soft tissue, so X-rayswill definitely be used if fractures are suspected.

If there is a fracture, your doctor may also suggest a CAT scan to make surethat the fracture is stable. The CAT scan is an X-ray test similar to both theMRI and a regular X-ray, because it can show both bones and soft tissues. CATscans are also able to produce X-ray "slices" taken of the spine, so each sectioncan be examined separately. The scan forms a set of cross-sectional images.With a compression fracture, an up and down perspective of the spine will bepieced together for examination of stability. The CAT scan is usually done tosee if the nerves are in danger from the fracture.

A neurological exam will also be given. This allows the doctor to test yourneurological responses, such as your reflexes, muscles, and sensory perception.Abnormalities on the neurological examination can point to nerve damage. Thenerves of the spinal cord carry messages from the brain to the rest of the body.If there is damage to the spinal nerves, your body movement and neurologicalresponses will be affected.

If there is a chance that nerves are involved in the fracture, or if thereis some question about what is causing the pain, an MRI might be recommended.The MRI scan is a fairly new test that does not use radiation. By using magneticand radio waves, the MRI creates computer-generated images. The MRI is ableto cut through multiple layers of the spine and show any abnormality of softtissues, such as nerves and ligaments.

A nuclear bone scan is another diagnostic test that might be ordered. Thistest helps determine the age of a fracture. If the fracture is old and thereappear to be other fractures that have healed, this may indicate osteoporosis(bone-thinning disease) is causing the fractures. This is important in olderpatients, particularly women. In this case, treatment of the fracture will includepreventive measures to try to stop other vertebral fractures from occurring.Such treatment could include: calcium supplements, increased vitamin D, weight-bearingexercises, and hormone replacement therapy for women.

For more information on all these tests, you may wish to review the documententitled:

Diagnostic Tests for Spine Problems

Treatment

The most common treatments for a thoracic compression fracture are: pain medications,decreasing activity, and bracing. In rare cases, surgery may also be necessary.

Pain Medications

Mild pain medications can reduce pain when taken properly. However, rememberthat medications will not help the fracture to heal. The medication is simplyto help with pain control.

To review the types of pain medications used for back pain please review:

Medications for Back Pain

Decreasing Activity

You will most likely have to limit your normal activities. You should avoidany strenuous activity or exercise. You will definitely need to avoid heavylifting and anything else that might place too much strain on your fracturedvertebra. If you are elderly, your doctor might also put you on bed rest. Olderbones take longer to heal and are typically thinner and weaker than youngerbones. Treat this fracture as you would any other broken bone - carefully andseriously!

Bracing

Another common form of treatment for some types of vertebral compression fracturesis bracing. Your doctor may prescribe a back support (often officially calledan orthosis). The brace supports the back and restricts movement; just as anarm brace would support a fracture of the arm. The brace is well molded to conformtightly to your body, like a cast for any other fracture. The brace used totreat a compression fracture of the spine is designed to keep you from bendingforward. It holds the spine in hyperextension (meaning more extension, or straightening,than normal). This takes most of the pressure off the fractured vertebral body,and allows the vertebrae to heal. It also protects the vertebra and stops furthercollapse of the bone.

Vertebral fractures usually take about three months to fully heal. X-rays willprobably be taken monthly to check on the healing progress.

To learn more about the different types of braces available to treat compressionfractures you may wish to review the document entitled:

Back and Neck Braces

Surgery

Surgery to fix most spinal compression is rarely needed. With vertebral fractures,surgery, or internal fixation, is only considered if there is evidence of suddenand serious instability of the spine. For instance, if the fracture leads toa loss of 50% of the vertebral body's height, surgery might be necessary toprevent damage that is more serious to the spinal nerves.

If your doctor feels that surgery is necessary to treat your fracture, he orshe will probably suggest using some type of internal fixation to hold the vertebraein the proper position while the bone heals. If there are signs that there istoo much pressure on the spinal cord, the bone fragments pushing into the spinalcord may also need to be removed.

Anterior Approach

When surgery is necessary to remove pressure from the spinal cord, your surgeonmay suggest an operation from the front of the spine. During an anterior approachan incision is made in the chest to allow the surgeon to see the front of thespine and locate the vertebra that has been crushed. One the vertebra has beenlocated, the bone fragments may be removed to remove the pressure from the spinalcord. Once this has been accomplished a spine fusion is usually performed.

The anterior spine fusion is performed by replacing the crushed vertebra withbone graft to hold the vertebra above and below the fractured vertebra apart.The bone graft eventually grows together with the vertebra above and below andfuses the vertebra together into one bone. During the operation a combinationof metal screws, metal plates and metal rods are used to hold the spine in thecorrect position to allow the fusion to occur over the next several months.These metal implants will remain in the body and will not be removed unlessthey cause problems.

Posterior Approach

In some cases, an operation to stabilize the fractured vertebra can be performedthrough an incision in the back. This type of procedure can allow the surgeonto use metal screws and metal rods to hold the vertebrae in the correct alignmentwhile the fractured vertebrae heals. The posterior approach is more useful whenthere is not a great deal of pressure on the spinal cord and the surgeon istrying to prevent the fractured vertebra from collapsing more.

For more information on this type of surgery, you may wish to review the document,entitled:

Instrumented Lumbar Spine Fusion

Spinal surgery is obviously a serious undertaking. Because of the risks andcomplications associated with spinal surgery, internal fixation is only donein serious cases.

Complications

With any surgery, there is a risk of complications. When surgery is done nearthe spine and spinal cord these complications (if they occur) can be very serious.Complications could involve subsequent pain and impairment and the need foradditional surgery. You should discuss the complications associated with surgerywith your doctor before surgery. The list of complications provided here isnot intended to be a complete list of complications and is not a substitutefor discussing the risks of surgery with your doctor. Only your doctor can evaluateyour condition and inform you of the risks of any medical treatment he or shemay recommend.

Please review the document entitled:

Complications of Spine Surgery

Several specific complications can occur with a vertebral compression fracture.If you notice or suspect a complication, please contact your doctor immediately.

Segmental Instability

If a fracture leads to a vertebral body collapse of more than 50 percent, thereis a risk of segmental instability. Each spinal segment is like a well-tunedpart of a machine. All of the parts should work together to allow weight-bearing,movement, and support. A spinal segment is composed of two vertebrae attachedtogether by ligaments, with a soft disc separating them. The facet joints fitbetween the two vertebrae, allowing for movement, and the foramen between thevertebrae allow space for the nerve roots to travel freely from the spinal cordto the body. When all the parts are functioning properly, all spinal segmentsjoin to make up a remarkably strong structure called the spine. When one segmentdeteriorates, or collapses, to the point of instability, it can lead to localizedpain and difficulties. The instability eventually results in faster degenerationof the spine in this area.

Kyphotic Deformity

Though the thoracic spine is supposed to be curved (or kyphotic), if the curvein a person's thoracic spine is more than 40 to 45 degrees, it is consideredabnormal. Sometimes this deformity is described as "round back posture" or "hunchback".It is a common disorder in elderly women who have osteoporosis and frequentfractures. The front of the vertebrae will collapse and wedge due to the lackof normal vertebral space. This condition leads to a more rounded thoracic spine.

Neurologic Complications

If the fracture causes part of the vertebral body to place pressure on thespinal cord, the nerves can be affected. There is some space between the spinalcord and the edges of the spinal canal. However, this space can be reduced ifthe pieces of the broken vertebral body push into the spinal canal. The bonytube of the spinal canal cannot expand if the spinal cord or nerves requiremore space. If anything begins to narrow the spinal canal - such as if the vertebraeprotrude into its space, the risk of irritation and serious injury of the spinalcord or nerves increases.

The narrowing of the spinal canal due to a compression fracture can eitherlead to immediate injury to the nerves of the spine, or irritation of the nerveslater. If the irritation on the spinal nerves comes later (even after the fracturehas healed), it can cause pain and problems with the nerves not working right.The lack of space can also cause the supply of blood and oxygen to the spinalcord to be reduced. When the spine needs more blood flow during increased activity,the blood vessels may not be able to swell to get more blood to the spine. Thiscan lead to numbness and pain in the nerves that are affected. The nerves alsolose some of their mobility when the space available to them is reduced. Thisleads to irritation and inflammation of the nerves. This condition is calledspinal stenosis. For more information on spinal stenosis, you may wish to reviewthe document, entitled:

Lumbar Spinal Stenosis

All of these conditions may lead to the need for surgery in order to reducepressure on the spinal cord, or to stabilize the spine. Surgery might also benecessary to reduce pain and/or the danger of neurological problems.

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