What you need to know
During the aging process, the bones in the body begin to thin and weaken. This condition is called osteoporosis. Small micro fractures occur in the weakened bone, which eventually add up and cause the vertebra to collapse. This is called an insufficiency compression fracture .
Women over the age of 50 are susceptible to these issues from menopause. The decreased estrogen causes increased breakdown of the bony tissue, making the bones extremely brittle unable to support the weight of the spinal column. Caucasion and Asian women, thin women, and smokers are at increased risk.
The majority of compression fractures compress the front of the vertebra and instead of maintaining a square shape, create a wedge shape vertebra. If a patient sustains enough of them, their posture changes to being severely stooped and they develop kyphosis or gibbus deformity. This is called a Dowager’s hump.
Patients are usually first diagnosed by performing plain x rays which show collapse of the vertebra. The acuity is usually demonstrated by performing a MRI which also can show if any bone is pushed into the back of the spinal canal compressing the spinal cord or any nerves. A CT scan can be performed in the event an MRI cannot be obtained.
Patients who sustain these injuries are usually recommended to undergo a bone density test to assess the severity of the osteoporosis. They are further encouraged to begin bisphosphonate therapy which can be administered by mouth (actonel, fosamax, boniva) or intravenously.
Acute fractures can be treated with various braces such as a thoracolumbar orthosis (TLSO) and analgesics to decrease the symptoms. Patients who fail conservative care for the first 6-8 weeks may become candidates for a minimal invasive vertebral body augmentation, ie, kyphoplasty.
Open Decompression & Fusion
During an open decompression, a small section of the lamina (the bony roof of the spine) is removed to make more space for the nerves. This also widens the canal and relieves pressure on the spinal cord. This procedure may also require fusing the spinal column if the decompression causes spinal instability.
Patrick J. Horan, MD, MBA, FACS
Patrick J. Horan is an orthopaedic surgeon and sports medicine specialist with two decades of experience. He is board-certified in orthopaedic surgery and sports medicine. After receiving his undergraduate degree from Duke University in Durham, N.C., Dr. Horan earned his medical degree from Tufts University School of Medicine in Boston. Residency and Internship were both completed at Walter Reed Army Medical Center in Washington, D.C. He also received an MBA from Auburn University in Auburn, Ala.
Dr. Horan served 10 years on active duty in the US Army as an orthopaedic surgeon before entering into private practice. Dr. Horan is the founder of the Westchase Orthopaedic and Rehabilitation and the official surgeon of the Tampa Bay Rowdies. He maintains professional memberships with the American Academy of Orthopaedic Surgeons, the American Academy of Orthopaedic Sports Medicine and the Arthroscopy Association of North America.
Tampa’s Top Doctors!