Compression Fractures

Compression fractures refer to a specific type of bone injury, predominantly affecting the vertebrae within the spine. These fractures are characterised by the collapsing of the bone onto itself, which usually results from a reduction in bone strength or density.

Although compression fractures can occur in any part of the spine, they are most frequently observed in the thoracic region (the mid-back) and the upper lumbar region (the lower back).

Compression fractures often result from conditions that weaken the bone structure, increasing the susceptibility of the vertebrae to collapse under normal pressure.

• Osteoporosis
  This is the most prevalent cause of compression fractures. Osteoporosis leads to decreased bone density and quality, rendering bones more fragile and prone to fractures even with minimal stress. It primarily affects older adults, particularly postmenopausal women.
• Trauma
  Compression fractures can also result from traumatic events such as falls, forceful jumps, or car accidents. In younger individuals without bone density issues, these high-impact events can lead to compression fractures.
• Pathological Fractures
  These fractures occur due to pathological changes within the bone, often associated with cancer or other diseases that weaken the bone structure.
• Steroid Use and Other Risk Factors
  Long-term use of corticosteroids can lead to reduced bone density, increasing the risk of compression fractures. Additional risk factors include certain medical conditions, lifestyle choices, and genetic predispositions impacting bone health.

The primary goals of non-surgical treatment are to manage pain, stabilise the fracture, and prevent future fractures.

• Pain Management: This typically involves the use of medications. Over-the-counter pain relievers like acetaminophen (Tylenol) may be recommended. In some cases, stronger prescription pain medications or muscle relaxants might be necessary.
• Activity Modification: Patients are often advised to modify their activities to avoid movements that exacerbate pain or put additional stress on the spine.
• Bracing: A brace can be used to support the spine and limit movement, allowing the fracture to heal. It also helps in reducing pain and correcting posture.
• Physical Therapy: Physical therapy plays a key role in recovery. It includes exercises to strengthen the back muscles, improve posture, and increase flexibility, which can help support the spine and reduce the risk of future fractures.
• Osteoporosis Treatment: If the compression fracture is due to osteoporosis, treating the underlying osteoporosis is important to prevent future fractures. This may include medications that strengthen bones, dietary changes, and supplements like calcium and vitamin D.

In cases where non-surgical treatments are not effective or when the compression fracture leads to severe symptoms, surgical options may be considered. These procedures aim to reduce pain, stabilise the fracture, and restore the height or alignment of the vertebra.

• Vertebroplasty
  This minimally invasive procedure involves the injection of a special cement into the fractured vertebra. The cement hardens and stabilises the fracture, which helps to reduce pain. Vertebroplasty is usually done under local anaesthesia and sedation.
• Kyphoplasty
  Similar to vertebroplasty, kyphoplasty involves the insertion of a balloon into the vertebra before injecting the cement. The balloon is inflated to create space and restore some of the height lost due to the fracture, after which it is deflated and removed, and the space is filled with cement.
• Spinal Fusion Surgery
  In more severe cases, particularly when there is spinal instability, spinal fusion surgery might be necessary. This involves joining two or more vertebrae together using bone grafts and metal rods or screws. This procedure can provide significant pain relief and stabilise the spine but is more invasive and has a longer recovery time.

Preventing compression fractures primarily involves addressing the risk factors and underlying conditions that contribute to weakened bones. Here are key strategies:

• Maintain Bone Health: This includes a diet rich in calcium and vitamin D, regular weight-bearing and strength-training exercises, and avoiding smoking and excessive alcohol consumption. These practices are crucial for maintaining bone density and strength.
• Osteoporosis Screening and Treatment: Regular screening for osteoporosis, particularly for those at higher risk such as postmenopausal women and older adults, is important. If diagnosed, following a treatment plan to strengthen bones can significantly reduce the risk of fractures.
• Medication Review: Regular review of medications with an orthopaedic surgeon can help identify drugs that may contribute to bone loss or increase the risk of falls.
• Regular Check-Ups: Regular check-ups with an orthopaedic surgeon can help monitor bone health and address any early signs of bone density loss.