Treating spinal bone fractures

Acute spinal bone fractures can cause back pain. The pain is usually felt at the fractured bone or in the surrounding area. It can be mild or severe, dull or stabbing, and get worse when sitting, standing, walking or bending. The pain might get better when lying down. The back muscles sometimes tense or cramp up, restricting your mobility. The skin around the fractured vertebra might be sensitive to touch. About 10% of those affected have such bad pain that they need treatment in a hospital. The pain sometimes spreads to other areas of the body.

If someone has several vertebral fractures over time, it can result in a stooped posture or what's often called a "dowager's hump" at the top of their spine. Having a very curved spine can also constrict your lungs.

Osteoporosis-related vertebral fractures are a type of fracture known as ‘compression fractures.’ They occur when a weakened spinal bone collapses under strain. It is usually the front part of the bone that collapses. These fractures are also called wedge fractures because the collapsed spinal bone looks wedge-shaped from the side. Most vertebral fractures happen where the thoracic spine (upper back) meets the lumbar spine (lower back).

Even small amounts of strain can cause a fracture if the spinal bones are very weak. This includes certain movements, like lifting shopping bags incorrectly. Sometimes violent coughing or sneezing are already enough to fracture a spinal bone.

It takes about three months for a fractured spinal bone to heal. The pain usually starts to get much better within 4 to 6 weeks. If it lasts longer than three months, it's considered to be chronic. Chronic pain can be a sign of a poorly healed fracture, but there are also other possible causes.

Painkillers can relieve acute pain. Depending on the severity of the pain, various medications can be used:

• Mild pain can be relieved with anti-inflammatory painkillers like ibuprofen, the painkiller metamizole, or weak opioids like tramadol. Some of them are taken as tablets, others are used as patches that are placed on the skin.
• Severe pain can be treated with stronger opioids. If necessary, they can be given through a drip in hospital.

Painkillers also help people to get active again sooner. The general advice for people with a fractured vertebra is to get moving again as soon as possible, and avoid long periods of bed rest. If you don’t move for extended periods of time, your bones and muscles will get weaker more quickly. Bed rest also increases the risk of other problems, such as thrombosis.

As well as treatment with painkillers, you can have physical therapy to carefully move, massage and stretch your back with the help of suitable exercises. The aim is to relieve the symptoms and improve mobility. Physical therapists sometimes also use passive treatments here.

Back braces (orthoses) can sometimes be worn to take the strain off the spine. They usually restrict movement and straighten the back. The aim is to prevent painful movements, take the strain off the spine, and help the fractured bone to heal. But using a back brace over a long period of time can make your muscles weaker so it is not recommended.

Fractured vertebrae can also be treated with bone cement injections. This is usually done using one of two main procedures:

• Vertebroplasty: Here the paste-like bone cement is injected into the fractured spinal bone. The bone cement then hardens within a few minutes.
• Kyphoplasty: In kyphoplasty, a balloon is inserted into the spinal bone and inflated. This straightens up the collapsed bone. Then the bone cement is injected.

Both procedures can be carried out under local or general anesthetic, in an outpatient setting or in hospital.

Several good-quality studies have compared bone cement treatments with a placebo treatment. The people in the placebo group thought that they had received a bone cement injection, but they hadn't. The result of the comparison: The pain got better in both groups – with no difference between those who actually received bone cement treatment and those who didn't (see illustration).

In other words, the bone cement treatment generally didn't noticeably relieve the symptoms within that time period.

But sometimes there are still reasons to consider bone cement treatment. If the fracture is only a few weeks old, the pain is very severe, and the spinal bones are very porous, bone cement treatments might be able to relieve the pain a little in some affected people. Because the procedure can also lead to complications in rare cases, it's a good idea to carefully consider the pros and cons. The possible complications include spinal cord injury and life-threatening blocked blood vessels that can develop if bone cement gets into the bloodstream.

There are currently no studies comparing kyphoplasty with a placebo procedure. But studies comparing vertebroplasty and kyphoplasty have not found any differences between the two. This suggests that kyphoplasty doesn’t have any advantages.

After having acute treatment, it's a good idea to become active again as soon as possible in order to prevent further fractures. Specific exercise therapy also prevents falls effectively. Falls are the main cause of osteoporosis-related fractures. It is also important to treat other health problems that increase the risk of fractures.

Certain medications can reduce the risk of bone fractures, too. Drugs known as bisphosphonates are mainly used here. Because they can also have side effects, it's worth carefully considering their potential pros and cons in your specific situation. You can also do a lot yourself to reduce the risk of fractures, like removing tripping hazards from your home.

Pain that lasts for more than three months can be a sign of a poorly healed fracture, but it might also have a different cause. Fractured spinal bones that go unnoticed at first can sometimes cause back pain later.

If you have chronic pain, it's a good idea to have further examinations to check how the fracture is healing and look for other causes. It is not always possible to find an exact cause of this kind of pain. Then treatments like medication and bone cement procedures don't help, or only help a little, and are only suitable in combination with other treatments.

The main treatment options for chronic pain are:

• Exercise therapy with specific suitable exercises: The aim is to reduce sensitivity to pain by gradually increasing the strain on the spine.
• Relaxation techniques: These can be used to reduce stress, tension and anxiety – factors that can make pain worse. Examples include progressive muscle relaxation and autogenic training.
• Behavioral therapy: Here you learn strategies that can make it easier to cope with pain in everyday life. This includes things like identifying and changing behaviors and thought patterns that make the pain worse.
• Pain rehabilitation: In pain rehabilitation programs, doctors, physical therapists, sports scientists and psychotherapists work together to treat chronic pain using various approaches. This usually involves a mixture of treatments in a group setting and one-to-one treatments. Some types of rehabilitation treatment are given during individual outpatient appointments, sometimes you visit a day center and go home in the evening, and sometimes you have to stay overnight. Pain rehabilitation treatment is also called “multimodal pain management.”