There are many causes of back pain, from arthritis to a muscle strain. One of the less common causes of low back is thoracic and lumbar compression fractures. While compression fractures can happen in anyone, they are most common in elderly females with osteoporosis. Osteoporosis is a condition which causes the bones to become weaker. When the bones become weaker, this makes it easier to fracture them. Osteoporotic fractures do not require a high impact activity, they often occur from a simple injury such as lifting or bending. Often patients do not even remember an injury, making it possible for patients to be unaware that they even have a fracture.
A compression fracture is generally characterized as a wedge compression fracture meaning there is a fracture of the vertebral body affecting the front or anterior portion of the vertebral body. A more severe fracture is called a burst fracture which involves both the front and back walls of the vertebral body. These fractures can be unstable and can often fracture into pieces which can push against the nerve and cause neurologic issue such as pain or weakness. Burst fractures do often require a higher impact activity, unlike osteoporotic compression fractures.
Common symptoms of compression fractures:
• Acute onset of severe low back pain
• Pain that is worse with standing and walking
• Pain with transitions, especially getting in and out of bed
• Decreased range of motion secondary to pain
Treatment of compression fractures varies depending on the fractures. Wedge compression fractures can often be treated conservatively (without surgery) with rest and pain medication. We restrict our patients on things like lifting and bending/twisting for up 3 months as the fracture heals. We instruct our patients to not lifting anything greater than 10-15 pounds and avoid any excessive/repetitive bending and twisting. There are certain situations when a brace is warranted. We consider bracing for fractures that have increased kyphosis (the outward curvature of the spine) and worsening pain. There are several types of braces, a lumbar support brace which wraps around the low back and abdomen and a TLSO (thoracolumbosacral orthosis) brace that wraps around the low back, abdomen and extends up the chest and around the shoulders. These braces will give the patient more comfort and help decrease pain, they also allow the fracture to heal in appropriate alignment. Lumbar support and TLSO braces should be worn at all times when standing and walking. After 2-3 months of restrictions, physical therapy is considered if patients have persistent pain.
We may consider a surgery such as a kyphoplasty or fusion if the alignment of the fracture worsens, causing increased kyphosis, if there is worsening unmanageable pain or neurologic injury such as radiating leg pain or weakness. If you develop a fracture it is important to monitor for any of these worsening symptoms. As we discussed, osteoporosis is one of the most common causes of compression fractures. Osteoporosis can be managed with certain medications as well as an appropriate intake of daily vitamin D and calcium. It is important to keep your health screenings especially bone density tests up to date to best avoid a fracture. Something as simple as weight bearing activities, can help strengthen your bones, so keep walking and stay safe!