Vertebral fracture
A vertebral fracture is a serious condition that may arise from trauma, osteoporosis or malignant disease and can significantly affect quality of life.
Early diagnosis and an individualised management plan are crucial for pain relief, prevention of complications and successful recovery.
What is a vertebral fracture?
The vertebrae are the bones that form the spinal column and protect the spinal cord and nerve roots. When a vertebra sustains a fracture, its structure is disrupted and the vertebral body becomes compressed, losing its normal rectangular shape.
A compression fracture of the vertebra is the most common type and is usually located in the lumbar spine. It typically involves the anterior part of the vertebral body, giving it a wedge-shaped appearance. The more vertebrae that are affected, the more pronounced the deformity of the spine becomes.
In more severe cases, the fracture may lead to narrowing of the spinal canal and nerve compression, with corresponding neurological manifestations.
What are the causes?
Spinal vertebral fractures are classified into three main categories based on their underlying cause.
Osteoporotic vertebral fracture
Osteoporosis is the commonest cause of vertebral fractures, particularly in postmenopausal women and older adults. It reduces bone density and strength, so that even a minor movement or fall may be sufficient to cause a fracture. In advanced cases, a fracture may occur spontaneously, without any obvious injury.
Traumatic fracture
A traumatic vertebral fracture is caused by high-energy forces, such as a road traffic accident, a fall from height or a sports injury. These fractures may be unstable and require urgent surgical management.
Pathological fracture
A pathological fracture occurs when a vertebra has been weakened by malignant disease, such as metastatic lesions or primary spinal tumours. Management in these situations is multi-layered and requires close collaboration with an oncologist.
Vertebral fractures are broadly classified into three main categories according to their underlying cause.
Symptoms of vertebral fracture
Symptoms vary depending on the type and severity of the fracture, but the most common include:
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Acute or chronic pain in the back or loin, worse with movement and standing.
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Loss of height, particularly in the case of multiple osteoporotic fractures.
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Kyphotic posture (stooping), with marked forward bending of the spine.
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Muscle spasms and stiffness around the fractured segment.
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Numbness, weakness or radiating pain in the limbs when there is nerve compression.
In unstable fractures accompanied by neurological symptoms, such as weakness of the legs or sphincter disturbance, urgent medical assessment is required.
How is the diagnosis made?
Diagnosis is based on a combination of clinical history, examination findings and imaging studies.
Standing plain radiographs are the initial investigation and demonstrate wedge deformity and overall spinal alignment and stability.
Magnetic resonance imaging (MRI) is the investigation of choice for assessing the acuity of the fracture, detecting nerve compression and distinguishing osteoporotic from pathological fractures.
Computed tomography (CT) provides a detailed view of bony anatomy and is essential for surgical planning.
Management
Management of a vertebral fracture is tailored to the type and severity of the fracture, its cause, and the age and general health of the patient.
Conservative treatment
Most stable vertebral fractures, particularly osteoporotic ones, are initially treated conservatively. Analgesia, relative rest and, where appropriate, use of a spinal brace form the basis of non-operative treatment.
At the same time, targeted treatment of the underlying osteoporosis with appropriate medication is vital to prevent further fractures.
Vertebroplasty and kyphoplasty
When conservative treatment fails to provide adequate pain relief, or in patients who are unable to tolerate it, vertebroplasty and kyphoplasty offer minimally invasive options with excellent results in pain control.
In both procedures, a hollow needle is guided under fluoroscopic control into the fractured vertebral body and a special bone cement is injected to stabilise it.
In kyphoplasty, a balloon is first inserted and inflated to create a cavity and partially restore the height of the vertebral body before cement injection. This makes kyphoplasty the preferred option in younger patients or in more recent fractures where height restoration is achievable.
These procedures are usually performed under general anaesthesia, and most patients are discharged home the following day.
Surgical stabilisation
In unstable fractures, in fractures associated with neurological complications, or in pathological fractures due to malignant disease, surgical stabilisation with spinal instrumentation (spinal fusion) is indicated. The operation aims to decompress neural elements, restore spinal alignment and stabilise the spine with implants.
The choice of technique is individualised, taking into account the anatomy, the number of affected levels and the overall condition of the patient.
Mr Mazarakis
Expertise and approach
Vertebral fractures, particularly pathological fractures due to malignant disease, represent a major part of Mr Mazarakis’ clinical subspecialty.
His training includes a complex spine fellowship at Leeds General Infirmary (Leeds), Queens Medical Centre (Nottingham) and Beaumont Hospital (Dublin), alongside extensive experience in the surgical stabilisation of complex fractures.
Recovery after vertebral fracture
Recovery time
The length of recovery after a vertebral fracture depends on the type of fracture and the treatment approach used.
Following vertebroplasty or kyphoplasty, most patients mobilise on the same or the next day and return to basic daily activities promptly. After surgical stabilisation, recovery is longer and full rehabilitation may take several weeks.
Physiotherapy
Physiotherapy plays a central role in recovery. Programmes focusing on strengthening the core muscles, improving balance and gradually resuming activity help reduce the risk of further fractures and enhance function.
Every patient with a vertebral fracture deserves a holistic approach that considers not only the fracture itself but also the underlying cause, age and functional needs.
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