Back (Lumbar)
Lumbar Compression Fracture
요추 압박 골절
Vertebral body collapse due to osteoporotic bone failure, causing acute back pain
- How common
- Common in Osteoporotic Patients
- Typical age
- Ages 60–80 (mostly women)
What is it?
Osteoporotic vertebral bone mineral density is insufficient to withstand normal loads. Minor trauma (or even spontaneous) causes anterior vertebral body compression, resulting in a wedge fracture.
Commonly affected: T12-L1, L1-L2 (thoracolumbar junction) most common
How it develops
- OsteoporosisPost-menopausal estrogen decline accelerates bone resorption, reducing BMD
- Minor TraumaMinimal force (lifting, coughing, or even spontaneous) fractures the weakened vertebra
- Anterior Vertebral CollapseAnterior column fails first — anterior wedge fracture with height loss
- Severe Pain & Functional LossPeriosteal irritation and paraspinal muscle spasm cause intense localized pain
Symptoms
- Acute Severe Back PainSudden, severe localized back pain following minimal activity
- Movement-Provoked PainAny movement dramatically worsens pain; relief with lying supine
- Localized TendernessPoint tenderness at the fracture level; percussion tenderness of spinous process
- Height Loss & KyphosisCumulative fractures cause progressive height loss and thoracic kyphosis
- Neurological Symptoms (Rare)Retropulsion of fragments may rarely cause radiculopathy or cord compression
How it is examined
- Percussion TendernessSpinous process percussion test: sharp localized pain at fracture level
- Extension PainPatient unable to extend spine; stands in flexed posture
- Neurological ExaminationUsually normal — perform to rule out cord or nerve root compromise
Imaging
Lateral X-ray shows anterior vertebral body height loss (wedge deformity). Posterior height preserved in pure compression fracture.
- Anterior vertebral height loss (wedge deformity)
- Increased kyphotic angle
- Diffuse osteopenia
MRI T2/STIR shows acute bone marrow edema (bright signal). Crucial to differentiate acute from chronic fractures and to rule out cord compression.
- STIR hyperintensity (marrow edema) — acute fracture
- Anterior vertebral collapse
- Assess for neural compromise
Non-surgical care
- Pain Management + RestAcute rest; strong analgesics (tramadol, opioids for severe pain)
- Osteoporosis Treatment (Essential)Bisphosphonates (alendronate), calcium + vitamin D, consider teriparatide
- Lumbar BraceThoracolumbar orthosis (TLSO) for stabilization and pain relief (6–8 weeks)
Conservative options are generally tried first. Medications listed here can have side effects — discuss them with your prescriber.
When surgery is considered
Severe pain not responding to 2–3 weeks conservative care; >50% height loss; neurological compromise
Procedures that may be discussed
- Vertebroplasty — PMMA cement injection
- Kyphoplasty — balloon height restoration + cement (preferred)
Outlook
Fractures heal in 6–12 weeks. Untreated osteoporosis leads to multiple fractures — treatment is essential.