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Vertebral Fracture: Causes, Symptoms & Treatment

A vertebral fracture is a break in one or more of the bones of the spine. It is most commonly caused by trauma, osteoporosis, or tumors.

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Things worth knowing about "Vertebral fracture"

A vertebral fracture is a break in one or more of the bones of the spine. It is most commonly caused by trauma, osteoporosis, or tumors.

What is a Vertebral Fracture?

A vertebral fracture is a break in one or more of the vertebral bodies that make up the spine. The spine consists of 24 movable vertebrae divided into the cervical, thoracic, and lumbar regions, as well as the sacrum and coccyx. Vertebral fractures can be classified as stable or unstable. In severe cases, they may involve injury to the spinal cord, potentially causing neurological damage.

Causes

The most common causes of a vertebral fracture include:

Trauma: Falls from a height, road traffic accidents, or sports injuries can lead to a fracture.
Osteoporosis: Reduced bone density means vertebral bodies can fracture under minimal stress, such as coughing or bending. These so-called osteoporotic compression fractures are especially common in older adults.
Tumors and metastases: Bone metastases or primary bone tumors weaken the vertebral body and increase fracture risk.
Inflammatory conditions: Diseases such as ankylosing spondylitis can reduce spinal stability.

Symptoms

Symptoms depend on the severity and location of the fracture. Typical complaints include:

Acute or chronic back pain, often with sudden onset
Worsening pain with movement, loading, or pressure over the affected area
Loss of height and development of a rounded back (kyphosis) in cases of multiple osteoporotic fractures
Radiating pain into the arms or legs if nerves are compressed
Numbness, paralysis, or bladder and bowel dysfunction if the spinal cord is involved (medical emergency)

Diagnosis

Diagnosis of a vertebral fracture involves various imaging techniques:

X-ray: First-line method to detect fractures and changes in vertebral shape.
Computed tomography (CT): Provides detailed images of bone structures and helps assess fracture stability.
Magnetic resonance imaging (MRI): Essential for evaluating the spinal cord, nerve roots, and soft tissues, and for distinguishing fresh from old fractures.
Bone density measurement (DXA scan): Used when osteoporosis is suspected.

Treatment

Conservative Treatment

Stable vertebral fractures without neurological deficits are often treated conservatively:

Pain management with analgesics
Rest and activity restriction
Wearing a supportive brace or orthosis
Physiotherapy to strengthen the back muscles
Treatment of the underlying condition (e.g., osteoporosis therapy)

Minimally Invasive Procedures

For osteoporotic fractures, minimally invasive methods are frequently used:

Vertebroplasty: Injection of special bone cement into the fractured vertebral body to stabilize it.
Kyphoplasty: A balloon is first inserted into the vertebral body and inflated to restore height, then bone cement is injected.

Surgical Treatment

Unstable fractures or those with neurological deficits often require surgical intervention:

Decompression of the spinal cord or nerves
Stabilization with screws, rods, or plates (spinal fusion / spondylodesis)
Restoration of normal vertebral body shape

Prognosis and Prevention

The prognosis of a vertebral fracture depends strongly on the severity of the injury, the age of the patient, and any underlying conditions. Stable fractures typically heal within 6 to 12 weeks. To prevent osteoporotic fractures, adequate calcium and vitamin D intake, regular physical activity, and medication-based osteoporosis treatment when needed are recommended.

References

World Health Organization (WHO): Guidelines for the Management of Osteoporosis, WHO Press, Geneva.
German Society for Trauma Surgery (DGU): S2k Clinical Guideline on Vertebral Fractures, AWMF Registration No. 012-001, 2022.
Pfeifer M. et al.: Osteoporotic Vertebral Fractures – Diagnosis and Treatment. Deutsches Arzteblatt International, 2009; 106(34-35): 563–571.

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