With aging populations and osteoporosis prevalent in spite of medical therapy, compression fractures, especially in the thoracic and lumbar spine, occur. Lumbar compression fractures almost never involve neurologic injury and are generally self limited. They can be very painful; sometimes even necessitating bed rest. In these cases the anterior structures of the spine, the vertebral body, lose enough bone mass to become weaker.
Ordinary stresses may cause a slight buckling of the anterior portion of the vertebral body, and the body may end up wedge shaped. Sometimes massive collapse will occur, and the vertebra becomes almost pancake shaped. With this collapse, there is added forward shift and pressure on the structures. These are acute fractures and are painful. Sometimes if the fracture and deformity occur very slowly, there may be almost no pain and the fracture may be picked up by routine exam or X-ray. Typically, the round back appearance or hump back is seen in women over 70, but it does also occur in men.
Treatment of the lumbar compression fracture typically involves rest and ambulation as soon as reasonably comfortable. Bracing is not usually done except in lumbar fractures, as braces are generally uncomfortable for those patients with thoracic fractures and not very effective. Surgical reconstruction is also difficult, either from the front or back approach. Spinal implant fixation is very difficult in the osteoporotic spine, but these spines can heal into a solid fusion. One other problem is that if you stiffen several segments in fusion in an osteoporotic spine, there will be additional stresses delivered to the first open motion segment, and this vertebra often fractures later.
