Have you ever had severe back pain? If you answered no to this question, you should consider yourself fortunate. It is estimated that up to 80 percent of people will experience at least one episode of back pain during their lifetime with symptoms severe enough that they will miss work or seek medical attention.
There are many causes of back pain and as our population ages, degenerative diseases of the spine and osteoporosis will result in an increase in episodes of back pain in the U.S. population.
Vertebral Body Compression Fractures
More than 750,000 Americans will suffer a vertebral body compression fracture in 2016. A vertebral body compression fracture is a type of fracture in the spine in which a vertebral bone has decreased at least 15 to 20 percent in height due to fracture. They are followed by acute back pain and may lead to chronic pain, deformity, loss of height, and crowding of internal organs.
As most of these fractures are a result of osteoporosis, the majority of them will occur in postmenopausal women and older men. It is estimated that 25 percent off postmenopausal women will have at least one vertebral body compression fracture during their lifetime. Other causes of these types of fractures including weakening of the bones due to spread of cancer. They may also be seen in some patients with normal bone strength after a fall.
As with most episodes of acute back pain, vertebral body compression fractures also typically heal themselves. Symptoms of a compression fracture resolve in up to two-thirds of patients when given 4-6 weeks of conservative measures such as pain control and rest.
When to Seek Medical Attention
How do you know when to seek medical attention if you have severe back pain?
Severe back pain that lasts longer than a week, pain that does not respond to over-the-counter pain medications, pain that is a result of a fall or results in weakness or numbness in your legs should prompt you to seek medical attention. Loss of bowel or bladder continence is also a worrisome symptom.
Common to vertebral body compression fractures, patients will often experience worsening of their pain with movement, standing or riding in the car, especially when driving over bumps or potholes. Patients often also describe relief of their pain when laying on their back.
Prevention is Key
It is important to remember that prevention is the key in avoiding these type of fractures. A balanced diet, weight-bearing exercise, and not smoking are a few of the important steps you can take to avoid a compression fracture. In some patients, bone-strengthening medications, called bisphosphonates, are sometimes prescribed.
How a Vertebral Body Compression Fracture is Diagnosed & Treated
Vertebral body compression fractures are most often diagnosed with a plain x-ray. However, in order to see the detailed anatomy and completely characterize the fracture once it is discovered, a CT scan or an MRI of the spine are sometimes required.
The first steps and treatment of a vertebral body compression fracture involve rest, pain control, physical therapy and sometimes bracing. If these conservative measures fail to alleviate the pain, two minimally-invasive surgical procedures, called vertebroplasty and kyphoplasty, can be very helpful in many patients.
Vertebroplasty and kyphoplasty are very similar. Both procedures are performed on an outpatient basis with sedation and involve inserting a needle through the back into the fractured vertebra and injecting an acrylic bone cement into the bone to stabilize the fracture. Patients typically go home 1-2 hours after the procedure. Both of these procedures have a very low risk of complication, typically less then 1-2 percent
Though no surgical procedure is guaranteed to help 100 percent of patients, these two procedures dramatically reduce pain in the vast majority of appropriately chosen patients, often immediately after the procedure.
Grant Linnell, DO, is a radiologist at the University of Vermont Medical Center and associate professor at the Larner College of Medicine at UVM.