Definition

A vertebral fracture is a condition characterized by a broken backbone, which can result from trauma or other medical conditions. The majority of vertebral fractures are caused by osteoporosis. Osteoporosis affects 200 million people worldwide, with 30% of women globally affected. Meanwhile, in vertebral fractures caused by trauma, 80% of cases occur in men. Vertebral fractures due to osteoporosis typically occur in the lower back (lumbar), while in trauma-related cases, half occur in the cervical (neck) area of the spine.

Causes

Vertebral fractures can occur due to trauma or medical conditions such as osteoporosis and cancer metastasis. Among all causes, osteoporosis is the most common. Osteoporosis is a condition characterized by reduced calcium levels in the bones, leading to bone loss and brittleness. As a result, the spine becomes vulnerable to fractures from minor activities like sneezing or lifting light objects. In individuals with osteoporosis, vertebral fractures often manifest as compression fractures, where the broken spine compresses the bone below it.

The second most common cause of vertebral fractures is trauma. Of all trauma types, motor vehicle collisions are the leading cause of vertebral fractures. Other causes include physical violence, falls, and gunshot wounds penetrating the spine.

In addition to osteoporosis and trauma, vertebral fractures can be caused by several other medical conditions, such as cancer metastasis. Cancerous tissue can spread to the spine, causing it to become brittle or even fracture. Besides cancer, other medical conditions that can cause vertebral fractures include osteomyelitis or bone infection.

Risk factor

The risk factors for vertebral fractures are related to their causes. Vertebral fractures due to osteoporosis are more common in women over 50 years old. Additionally, osteoporosis is more likely to occur in smokers, alcoholics, individuals with low estrogen levels (such as postmenopausal women), those with anorexia (an eating disorder resulting in extreme thinness), kidney disorders, vitamin D deficiency, long-term proton pump inhibitor (PPI) use for gastric disorders, and long-term steroid use due to autoimmune diseases.

Meanwhile, trauma leading to vertebral fractures is more common in men, with an average age of 32 years and a range of 16-30 years. This is because young men are more likely to drive motor vehicles and engage in high-risk activities that could potentially cause vertebral fractures.

Symptoms

Vertebral fracture symptoms can occur alone or simultaneously. Symptoms may include sudden back pain, which worsens when standing or walking and improves when lying down. Other symptoms may include limited spinal movement, decreased height, and abnormalities in spinal shape such as kyphosis (forward rounding of the spine) and disturbances in bodily systems. Systemic disturbances may include constipation, decreased respiratory effort, and physical inactivity. In the long term, if the patient remains physically inactive, complaints such as swelling and pain in the legs due to blood vessel blockage may arise. If the vertebral fracture affects the nerves in the spinal cord, symptoms of nerve damage such as muscle weakness or paralysis, numbness, and tingling may occur.

Diagnosis

Diagnosis of vertebral fractures can begin with inquiries about medical history. Typically, complaints that often prompt patients to seek help include acute or chronic back pain. Another common cause is a history of trauma. In trauma cases, understanding the chronology of the traumatic event is crucial to assessing the possibility of injuries to other body parts.

In cases of trauma, initial examinations will include ensuring airway patency and neck safety (airway), breathing (breathing), and circulation (circulation). In some cases, there may be a decrease in blood pressure and heart rate, known as neurogenic shock. Patient stabilization is required before further examinations. Further examinations may include a comprehensive neurological examination, which may involve examining the nerves of the head, touch, temperature, and movement, and assessing muscle strength in the anus to detect paralysis of the anal muscles.

Initial imaging examinations that can be performed include X-rays and computed tomography (CT) scans to check the condition of the spine and identify the fractured vertebrae. If the patient's condition is stable, magnetic resonance imaging (MRI) can be performed to assess tissue damage around the bone and in the spinal cord. Imaging such as a bone scan may be performed if there is suspicion of cancer metastasis to the spine.

Laboratory tests may also be performed as supportive examinations. These tests may include a complete blood count, blood sugar levels, inflammation marker proteins such as C-reactive protein (CRP), and erythrocyte sedimentation rate (ESR). These tests can serve as indicators of the cause of the fracture, such as bone infection. Biopsy or tissue sampling of the bone may also be performed to detect cancer metastasis in the spine.

Management

Management of vertebral fractures depends on the patient's initial condition. If a patient complains of chronic pain without signs of nerve disturbance and other significant daily functions, therapy aims to reduce pain and improve daily function. Pain management can be combined with rehabilitation programs such as physiotherapy. Physiotherapy is generally performed to improve body posture and reduce pain. Additionally, patients may need bed rest to accelerate bone recovery. The use of a corset is also recommended to increase patient comfort. If pain persists despite these efforts, surgery may be necessary. Surgery aims to stabilize the spine and maintain nerve function.

Meanwhile, if there is an injury to the spinal cord, therapy will involve medications and various devices to stabilize the patient's blood pressure. This stabilization is necessary to ensure that the body tissues receive sufficient oxygen. Stabilization may involve intubation or placement of a breathing tube, feeding tube insertion, intravenous infusion, as well as urinary catheterization. Surgery may be performed to relieve compressed or traumatized spinal cord and to stabilize the spine.

If there is an infection in the bone, intravenous antibiotic administration may be necessary to quickly deliver antibiotics to the bone tissue. Meanwhile, if there is a fracture caused by metastasis or cancer spread, therapy will be adjusted according to the type of cancer therapy.

Some patients may require psychological support. This support may involve counselling with mental health professionals. Other patients may need antidepressant and anti-anxiety therapy because vertebral fractures significantly affect daily life function.

Complications

Complications of vertebral fractures may be related to the disease course or treatment. Vertebral fractures can increase the risk of subsequent spinal fractures, muscle weakness, or paralysis, as well as the inability to perform daily activities such as bowel movements. Other complications may occur due to the patient's inability to move too much, such as pressure ulcers, or wounds on parts of the body that are pressed for too long due to unchanged body positions. Additionally, if there is an injury to the nerves controlling respiration, complications may include the inability of the patient to breathe normally, lung shrinkage, and lung infections (pneumonia).

Meanwhile, treatment-related complications may include complications from prolonged use of pain relievers. Prolonged use of nonsteroidal anti-inflammatory drugs (NSAIDs) can cause upper gastrointestinal bleeding and gastric ulcers. Opioid use can lead to addiction. Meanwhile, surgery can lead to complications such as surgical site infections, blood vessel blockages, and worsening conditions.

Prevention

Prevention of vertebral fractures can be done by maintaining a healthy diet, quitting smoking, and limiting alcohol consumption to promote bone health. In postmenopausal women, anti-osteoporosis medications are needed to prevent osteoporosis and spinal fractures. Meanwhile, in trauma, prevention measures include safe and cautious driving, always wearing seat belts when driving, not driving under the influence of alcohol, and maintaining safety during extreme sports.

When to see a doctor?

See a doctor promptly if you or someone near you experiences back pain and is over 65 years old or under 12 years old, if back pain occurs during rest similar to when active, drastic weight loss without efforts to lose weight, or a history of cancer. Go to the emergency room immediately if these symptoms are accompanied by the inability to control bowel movements or urination, severe pain accompanied by muscle weakness or paralysis and numbness, or high fever.

Looking for more information about other diseases? Click here!