Compression Fracture of the Spine: What It Is, Causes, and Symptoms

A compression fracture of the spine is a fracture of the vertebral body in which it is compressed and becomes lower than the adjacent vertebrae. It is most often associated with osteoporosis or trauma. This article explains what this injury is, why it occurs, what types of fractures exist, how it manifests, and how it is diagnosed.

What Is a Compression Fracture of the Spine?

Vertebrae are the bones that make up the spine. In a compression fracture, the vertebral body is compressed and becomes lower than the adjacent vertebrae, most often in the middle or lower back. On an X-ray, at least one compressed vertebra is visible that is shorter than the others. If there are multiple fractures, the back bends forward—kyphosis, or a "widow's hump," develops; sometimes a lateral curvature—scoliosis—also appears.

Causes: Trauma and Osteoporosis

The most common cause is osteoporosis, in which bones become fragile. Another group is trauma: road traffic accidents, falls from a height of 2–3 meters (catatrauma), sports injuries, gunshot wounds. Less commonly, a vertebra fractures due to a tumor that has spread from another organ or grown in the spine, for example in multiple myeloma. When bone strength is reduced, a fracture can occur during ordinary activities: coughing or sneezing sometimes causes partial collapse of a vertebra.

Osteoporosis develops over years and often first manifests as a fracture. The risk is higher in postmenopausal women, especially with early menopause (before age 45), with long-term steroid use, certain inflammatory and hormonal diseases, a family history of hip fracture, eating disorders, low body mass index, smoking, and alcohol abuse.

Types of Vertebral Injuries

In the thoracolumbar region, the AO/ASIF F. Magerl classification is used. Based on the mechanism of injury, flexion type A is distinguished—with compression and bending, extension type B—with distraction and extension, and rotational type C—with concomitant axial rotation. In the cervical region, compression injuries are divided into wedge, burst, and comminuted fractures of the vertebral bodies.

Symptoms and Signs of a Fracture

A traumatic fracture usually makes itself known immediately: the pain is sharp, "like a knife," in the middle or lower back, sometimes radiating to the side or forward. It can be immobilizing and persists for weeks or even months. A fracture against the background of osteoporosis often occurs without symptoms and is found incidentally on an X-ray taken for another reason. Gradually, other signs appear:

• pain begins slowly and worsens when walking, but is absent at rest;
• height decreases—by a total of up to 15 cm over the years;
• posture changes, the back becomes stooped;
• rarely—spinal cord compression due to stooping: numbness, tingling, weakness, difficulty walking, loss of bowel and bladder control.

Compression Fracture in Older Adults

Most compression fractures occur in older adults with osteoporosis, and the spinal cord is usually not affected. Osteoporotic fractures often become less painful over time but can cause chronic pain and limited mobility. Loss of height and stooping remain. Recovery after a traumatic fracture usually takes 8–10 weeks. Osteoporosis medications prevent new fractures but do not restore the previous shape of an already fractured vertebra; women are checked for bone density at age 65 or earlier if at increased risk.

How the Diagnosis Is Made and What Complications Occur

The doctor examines the back, assesses posture, looks for tenderness over the affected vertebra, and measures height. An X-ray shows a compressed vertebra that is lower than the adjacent ones. Next, densitometry (DEXA) is ordered—a painless bone density test lasting 10–20 minutes. The result is expressed on the T-score: above −1 is normal, from −1 to −2.5 is osteopenia, below −2.5 is osteoporosis. CT or MRI is performed if a tumor, severe trauma, or nerve damage is suspected.

Complications: kyphosis, spinal cord or nerve root compression, nonunion of bones after surgery. Medical attention should be sought if back pain is present and a fracture is suspected, symptoms worsen, or problems with bowel and bladder control appear.

A compression fracture by itself is not a reason to call an ambulance. Call 103 or 112 for numbness, tingling, weakness, difficulty walking, or loss of bowel and bladder control, as well as for severe trauma—a road traffic accident or a fall from a height.

This material is for reference and does not replace a doctor's consultation: only a specialist can evaluate imaging and examination findings.

This content is for reference and does not replace a doctor's consultation. Medical disclaimer