A vertebral compression fracture is a collapse of the front of a vertebral body, most often in the thoracic or upper lumbar spine. It usually comes from osteoporosis after minor strain, but it can also follow major trauma or a tumor in the bone.
Key symptoms
- Sudden mid or low back pain after a minor lift, cough or fall
- Pain worse when standing or walking, better lying down
- Loss of height and a stooped posture
- Sometimes no symptoms; found on an X-ray
What you find on exam
- Point tenderness over the spinous process
- Increased forward curve of the upper back (kyphosis)
- Neurologic exam of the legs: strength, sensation, reflexes
- Questions about bladder and bowel control
Tests
- Spine X-ray: wedge-shaped vertebra
- MRI if neurologic signs, unclear fracture age or concern for tumor or infection
- DEXA scan for bone density
- Calcium, vitamin D, kidney function; blood count and protein studies if cancer is possible
Treatment basics
- Pain control with acetaminophen and NSAIDs, short-term opioids if needed
- Brief rest, then early walking; a brace for comfort in some patients
- Treat osteoporosis: calcium, vitamin D and a bisphosphonate such as alendronate
- Calcitonin can ease acute pain for a few weeks
- Fall prevention; vertebroplasty or kyphoplasty for selected persistent pain
Red flags
- Leg weakness, numbness or bladder or bowel changes
- Fever, history of cancer or weight loss
- Fracture after major trauma or in a young patient
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Sources: NCCPA PANCE Content Blueprint; NBOME COMLEX-USA clinical presentations; AAMC Core Entrustable Professional Activities (Core EPAs). Written by Making Synapses. Making Synapses is not affiliated with these organizations.