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Spinal compression fracture - diagnosis and treatment

Diagnosing a spinal compression fracture

Spinal compression fractures, also called vertebral compression fractures, are caused by one bone in the spine being compressed against another bone.

As well as being painful, spinal compression fracture can restrict movement.

However, spinal compression fractures can be hard to diagnose, as the symptoms can be mistaken for arthritis, aches and pains associated with ageing, spinal disc problems or muscle strain.

To determine what's wrong, your doctor may ask questions such as:

  • How long have you had the back pain?
  • What caused it?
  • What were you doing when it started?
  • Is the pain getting worse or better?

Your doctor may also recommend tests such as:

  • A spinal x-ray to determine whether a vertebra has collapsed
  • A CT scan to provide detail of the fractured bone and the nerves around it
  • An MRI scan to show greater detail of nerves and nearby discs.

Also, a bone biopsy may be done because a small percentage of patients have compression fractures caused by cancer.

Treatment for spinal compression fractures

If osteoporosis has caused a spinal compression fracture the treatment should address the pain, the fracture, and the underlying osteoporosis to prevent future fractures.

The majority of fractures heal with pain medication, reduction in activity, medication to stabilise bone density and a back brace to minimise movement during the healing process. Most people return to their everyday activities. Some may need further treatment, such as surgery.

Non-surgical treatment for spinal compression fractures

Pain from a spinal compression fracture allowed to heal naturally can last as long as three months. But the pain usually improves significantly in a matter of days or weeks.

Pain management may include analgesic pain medicine, bed rest, back bracing, and physical activity.

Pain medication. Over-the-counter pain medication is often sufficient in relieving pain. Two types of non- prescription medication, paracetamol and non-steroidal anti-inflammatory drugs ( NSAIDs), are recommended. Opioid pain medication and muscle relaxants are often prescribed for short periods of time, since there is a risk of addiction. Anti-depressants can also help relieve nerve-related pain.

Activity modification. Bed rest may help with acute pain but it can also lead to further bone loss and worsening osteoporosis, which increases the risk of future compression fractures. Doctors may recommend a short period of bed rest for no more than a few days. However, prolonged inactivity should be avoided.

Back bracing. A back brace provides external support to limit the movement of fractured vertebrae, much like applying a cast on a broken wrist. The rigid style of a back brace limits spine-related movement significantly, which may help reduce pain. However these should be used for only a short period of time since they can cause further weakness in the supporting muscles.

Osteoporosis treatment. Bone- strengthening drugs such as bisphosphonates help stabilise or restore bone loss. This is an important part of treatment to help prevent further compression fractures.

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