Ask Dr. Clary: What is a vertebral compression fracture?

Pain medicine specialist Dr. Andrew Clary encourages activity as part of a healthy lifestyle for everyone—including his older patients. “Fitness isn’t just for young professional athletes,” he points out. “I treat people of all ages; exercise can benefit everyone. But conditions like osteoporosis should be considered when planning activities because bone weakness can make you more vulnerable to a vertebral compression fracture.”

Typically, it takes a significant amount of trauma to injure bone. However, as we age over time, osteoporosis reduces bone density. Weaker bones are more fragile and more vulnerable to fracture. As a result, osteoporosis can make the bones supporting the spine particularly at risk for vertebral compression fracture injuries. Dr. Clary describes how vertebral compression fractures occur, explains the symptoms, and discusses available treatments.

How a vertebral compression fracture occurs

“We have a complex system of vertebrae and other little bones supporting our back,” Dr. Clary explains. “Especially as we reach the age of 60 and older, osteoporosis can make these bones weaker and more frail. So frail, in fact that simple bending, twisting, or even a sudden sneeze can compress a spinal bone and cause it to crack and fracture. I treated someone who was out walking the dog; when the dog tugged on the leash, my patient heard a crack. That’s all it took.” Although these breaks can occur in any part of the spine, bones in the lower back are most commonly affected.

Symptoms of a vertebral compression fracture

Vertebral compression fractures affect 750,000 people each year. Most noteworthy, elderly women are particularly at risk. Dr. Clary explains that about 80 percent of people with an osteoporosis-related vertebral compression fracture experience intense localized back pain. Other symptoms signaling a compression fracture include decreased lung capacity and sleeping difficulty. If the fracture is putting pressure on the spinal cord, there may also be sensations of numbness, tingling, or weakness. In cases where fracturing causes vertebrae to collapse, patients may experience loss of height or spine curvature that causes stooping. “One vertebral compression fracture increases your risk of additional fractures,” Dr. Clary cautions. “This is why I encourage people with symptoms to seek early medical evaluation.”

Conservative treatments for a vertebral compression fracture

Treatment for these fractures usually begins with conservative, nonsurgical therapies like rest, calcium and vitamin D supplements, medication, and bracing. “The research on effective treatment for these fractures is fascinating,” notes Dr. Clary. “We’ve learned that it’s better to limit bed rest for back pain. This is especially true for older patients; extended time in bed may cause them to develop problems like pneumonia. High doses of pain medications help to relieve discomfort. But medications have their own risks and side effects and aren’t a good long-term solution. Bracing is another treatment option, but it can be ungainly and uncomfortable. Many of the older women I treat care deeply about their public appearance. As a result, wearing a brace just doesn’t work for them.”

Vertebroplasty and kyphoplasty treatments for vertebral compression fractures

When a painful compression fracture doesn’t respond to conservative treatment, vertebroplasty or kyphoplasty treatments may be considered. “These treatments aren’t for everyone and are most successful when the vertebral compression fracture is recent,” notes Dr. Clary.

• The vertebroplasty procedure. This is a minimally invasive surgical treatment performed through a small puncture in the patient’s skin. A biopsy needle is used under X-ray guidance to repair the fracture. “Specially formulated bone cement is injected into the fracture to fill it and stabilize the bone,” explains Dr. Clary. “It’s an outpatient procedure that takes about 30 minutes. Notably, this is an exciting option because immediately after the procedure, 30 percent of patients are pain-free.”
• The kyphoplasty procedure. Like vertebroplasty, kyphoplasty is a minimally invasive procedure that injects bone cement into a fracture to stabilize it. However, it involves an extra step. Kyphoplasty is used when a vertebrae fracture has caused bone to collapse and create a spine deformity. Before the cement is injected, a special balloon is inserted and inflated inside the fractured vertebrae to restore bone height. “The goals of kyphoplasty surgery are to stop fracture pain, stabilize the damaged bone, and restore lost vertebral height,” says Dr. Clary.

Research makes a compelling case for vertebroplasty and kyphoplasty treatment

“Medicare data clearly show that people with vertebral compression fractures live longer and do better with surgical treatment than without it,” says Dr. Clary. “Remember, people who suffer these osteoporosis-related fractures are already frail. If you get a vertebral compression fracture and do not have surgical treatment, you have a 30 percent risk of dying within one year. However, if your fracture is treated with a vertebroplasty, the risk of death within a year drops to 21 percent. That’s a 9 percent improvement in survival.” Notably, kyphoplasty also increases survival rates: 85 percent of appropriate patients treated with a kyphoplasty are still alive a year later.

“I encourage patients experiencing compression fracture symptoms to get a prompt medical evaluation,” says Dr. Clary. “I’m here to provide an accurate diagnosis and review all of the treatment options available. Together, we’ll identify the treatment plan that’s best for you.”

Summit Orthopedics offers comprehensive spine expertise

Our back specialists diagnose spine problems and design custom treatment plans built on a conservative, nonsurgical approach. Most patients find relief through treatments including guided injections, specialized physical therapy, biofeedback, exercise, activity modification, and medication. When conservative care does not relieve symptoms, our highly skilled surgeons offer proven, evidence-based surgical options. Together with you, we will determine the right course of action.

Start your journey to a healthy spine. Find your spine expert, request an appointment online, or call us at (651) 968–5201 to schedule a spine consultation.

Summit has convenient locations across the Minneapolis-St. Paul metro area, serving Minnesota and western Wisconsin. We have state-of-the-art centers for comprehensive orthopedic care in Eagan, MN, Plymouth, MN, Vadnais Heights, MN, and Woodbury, MN, as well as additional community clinics throughout the metro and southern Minnesota.

More resources for you

• Meet Dr. Andrew Clary
• Read about the causes of osteoarthritis
• Ask Dr. Clary: How Do Regenerative Osteoarthritis Treatments Work?
• Read more in-depth about vertebroplasty and kyphoplasty

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