You’ve probably heard that the arch is one of the strongest shapes in nature. Architects have known this for millennia. That’s why arches are used in the construction of bridges, great vaulted cathedrals, and massive public buildings. Your spine is composed of a series of arches that give it strength—just like the Roman Coliseum, which has stood for nearly 2,000 years. But just as any building can fall, any bone can break. The vertebrae are no exception.
What is a Spinal Fracture?A typical vertebra is composed of a body, which is roughly the shape of a heart or a kidney, attached to a bony vertebral arch. Viewed from the top, it looks something like a crown. The vertebral arch and the back of the vertebral body together form a strong, protective ring around the spinal cord. A vertebral fracture is a broken vertebra. Vertebral fractures fall into two broad categories: traumatic (associated with injury) and pathologic (associated with disease or degeneration).
Traumatic FracturesIf enough force is applied, the bony arch of a vertebra can snap like a stick, particularly if you’re injured in a fall, a motor vehicle crash, or some other accident in which the vertebrae are subjected to sudden, forceful flexion (bending forward), extension (bending backward) or rotation (bending sideways). This kind of injury is called a traumatic fracture. Traumatic fractures can also develop over time if the vertebrae are subjected to sustained or repeated mechanical stress, such as running. In this discussion, we’ll focus on pathologic fractures.
Pathologic FracturesPathologic fractures usually affect the vertebral body, rather than the vertebral arch. This kind of fracture is less dramatic than a traumatic fracture because it usually doesn’t threaten the spinal cord (although it can) and because it develops slowly. Picture a crack running through an old teacup, with smaller cracks spreading out from the main fissure. Human bone, though, is strong and porous—more like coral than china. Cracks running through a vertebra make the bone crumble, rather than snap. As it does, the compromised portion collapses, losing height and becoming compressed. This is called a compression fracture. Loss of vertebral height is, in fact, the chief criterion by which compression fractures are diagnosed. Most pathologic fractures—those associated with osteoporosis, for example—are compression fractures. If the vertebral body cracks all over, the loss of height will be relatively even. If the lateral (side) portion is fractured, the vertebra will collapse on the fractured side. And if a fracture occurs in the front (anterior) portion of the vertebral body, the loss of height will be in the front. An anterior fracture creates a wedge-shaped vertebra. If similar fractures occur at adjacent levels, a hunched or stooped posture will result.
How Common is a Spinal Fracture?
What Causes Spinal Fractures?
What are Symptoms of a Spinal Fracture?
How is a Spinal Fracture Diagnosed?
- Mild (1) = 20–25% vertebral height reduction
- Moderate (2) = More than 25% but less than 40% reduction
- Severe (3) = Greater than a 40% reduction in vertebral height
Conservative Spinal Fracture Treatments
Physical TherapyPhysical therapy is often used in the management of spinal conditions. The goal of therapy is usually to strengthen the musculature surrounding the spine, thereby strategically redistributing some of the spine’s workload. In patients with fractures, however, that’s not the only endpoint. Other aims of therapy are to improve your gait (walking pattern) and body mechanics. A physical therapist can even teach you how to perform preoperative exercises that make it easier for you to tolerate surgery under conscious sedation (local anesthesia), thereby eliminating the risks associated with general anesthesia.
MedicationsFor pain relief, your doctor can recommend over-the-counter pain relievers or prescribe effective non-opioid medications such as nonsteroidal anti-inflammatory drugs (NSAIDs). In addition, certain antidepressant agents are useful for pain management even in patients without depression. Opioid (narcotic) pain relievers may be prescribed if necessary, depending on your diagnosis and medical history. If your fracture is osteoporosis related, your doctor may also recommend one or more of the following to maintain bone mass, build bone mineral density, prevent future fractures, and/or relieve pain:
- Vitamin D
- Bisphosphonates such as Fosamax
- Hormone replacement therapy (HRT) (in women)
- Synthetic calcitonin, a naturally occurring hormone produced by the human thyroid gland
- Teriparatide, a recombinant form of parathyroid hormone (PTH)