Vertebral Body Fracture: An Unrecognized Common Disease

A vertebral fracture or a vertebral fracture is in most cases a fracture of the vertebral body, but the vertebral arch, the transverse process or the spinous process of a vertebra can also be affected. A vertebral body can fracture not only with strong force, but also without external force during small movements. As a result, the stability of the spine suffers. Every year, almost 230,000 people between the ages of 50 and 79 suffer a vertebral fracture in Germany. Women and men are affected in a ratio of 10:6.

Vertebral body fracture: possible symptoms

Sudden back pain can be an indication of a vertebral fracture as well as:

  • A more or less severe back pain
  • Pain on movement
  • Malpositions
  • Bruises
  • Bruise marks

If a vertebra of the cervical spine (HWS) is fractured, head movements are possible only with pain or the head even remains in a forced posture. If the spinal cord was also injured, the following symptoms may occur:

  • Urinary and fecal incontinence
  • Paralysis
  • Sensory disturbances such as numbness
  • In extreme cases, paraplegia

With pre-damaged bone structure due to an underlying disease, the vertebral fracture sometimes goes unnoticed. Only the constant, excruciating back pain leads to its discovery.

Causes of vertebral fracture

Healthy vertebral bodies can fracture when subjected to strong forces, such as those that occur in a car accident with high impact speeds. Falls of all kinds, for example in sports such as horseback riding, skiing, or paragliding, also carry a risk of fracture. Sometimes, however, vertebrae fracture even without external force during light everyday stresses and sometimes even without the affected person noticing it right away. This is the case, for example, with:

  • Osteoporosis, the most common consequence of which is the vertebral fracture (this is then called a sintering fracture).
  • Bone tumors
  • Skeletal metastases
  • Bone inflammation (osteitis)
  • Bone softening (osteomalacia)
  • Rheumatic diseases

In a vertebral fracture caused by osteoporosis, the cover plate, or upper surface, of the vertebral body may be depressed. This is called a cover plate impression or a cover plate collapse.

This is how the diagnosis is made

The earlier a vertebral fracture is treated, the greater the chance of preventing irreparable consequences. After talking with the doctor and a subsequent physical examination that includes a check of nerve function, the injured spinal area is X-rayed in maximum flexion and extension. Another computed tomographic (CT) scan shows whether the fractured vertebral body is constricting the spinal canal. If necessary, a second imaging procedure, magnetic resonance imaging (MRI), is used. This reveals the intervertebral discs, ligaments and spinal cord.

Therapy for vertebral body fracture

The first step is to relieve pain with suitable preparations, such as painkillers. Other conservative measures are:

  • Physiotherapy to restore mobility.
  • Relaxed bed rest
  • Under certain circumstances, a daily wearing back corset or support corset (orthosis), especially in the case of vertebral fractures in the lumbar spine (lumbar spine).

If it is a so-called stable vertebral fracture, as it is in about 85 percent of cases, ligaments and soft tissues are not affected and the spinal canal is not constricted by the collapsed vertebra – healing can then usually take place without surgery. In so-called unstable vertebral fractures, there is often a displacement of fragments of the vertebral body against the spinal canal or even a severing of the vertebral arch. Surgical measures are then usually required.

Treatment by surgery

Treatment of a vertebral fracture can be done surgically in several ways: In balloon kyphoplasty, two cannulas are inserted into the vertebra and two balloons are advanced through them into the vertebra. The balloons are carefully inflated so that the vertebra slowly straightens. The resulting cavity is filled with bone cement. In vertebroplasty, a large hollow needle is inserted into the affected vertebra and bone cement is injected directly into the vertebral body without prior straightening. Any malalignment remains intact.In osteosynthesis, the bone fracture is surgically stabilized with screws or a plate. In spondylodesis, two or more vertebrae are stiffened, usually by attaching plates to the spine from the front and back. If an underlying condition such as osteoporosis has led to the vertebral fracture, it is essential that this is also treated.

Preventing a vertebral fracture

The only way to protect against external force, for example in road traffic, is to use seat belts, airbags or, in sports, a back protector. If there is an increased risk of osteoporosis, a bone density measurement should be performed. Physical activity such as muscle training with dumbbells, cycling, swimming and spinal gymnastics are important for the incorporation of calcium into the bones. Furthermore, a balanced diet rich in calcium (1 to 1.3 grams daily), mineral water containing calcium, and the intake of vitamin D (1,000 units daily) prevent increased bone loss. If osteoporosis already exists, then further bone loss can be inhibited with medication.