Understanding Vertebral Fractures: Causes, Symptoms, and Treatment Insights from a Case Study
- DR Dinesh Vats
- Aug 25, 2025
- 3 min read
INTRODUCTION
The human spine is made up of 33 vertebrae that are joined by articulations to form the backbone. The spine protects the spinal cord, maintains upright posture, supports body weight, and enables mobility.
Vertebral fractures may result from trauma, osteoporosis, infections, or metastasis. These fractures can damage the bone, surrounding ligaments, and even the spinal cord, leading to neurological deficits. Most vertebral fractures are known as compression fractures.
CAUSES (ETIOLOGY)
Osteoporosis – The most common cause; even a minor fall can result in a fracture.
Trauma – Falls, accidents, or direct impact.
Medical conditions – Vertebral metastasis, cancers, infections, kidney disease, hyperthyroidism, and prolonged steroid use [1].
Gastrointestinal conditions – Inflammatory bowel disease, celiac disease, or post-gastrectomy states that reduce nutrient absorption [2].
Medications & treatments – Long-term use of steroids, chemotherapy, radiotherapy, or proton pump inhibitors.
Lifestyle factors – Smoking and excessive alcohol consumption.
Deficiencies – Vitamin D, calcium, or postmenopausal estrogen deficiency.
Age and gender – More common in women over 50 years [3].
Types of Compression Fractures
Wedge Fracture – Anterior part of the vertebra collapses, forming a wedge shape. Less likely to cause neurological damage.
Crush Fracture – The entire vertebra is crushed; higher risk of neurological complications.
Burst Fracture – Bone fragments spread in multiple directions, often leading to spinal cord injury and requiring urgent care [4].
They can also be classified as:
Stable Fracture – Bone remains in place, minimal risk of spinal injury.
Unstable Fracture – Bone is displaced, often associated with ligament damage and neurological deficits.
Signs and Symptoms
Sudden onset of severe back pain after trauma.
Pain worsens with standing or walking, relieved by lying down.
Pain while bending or twisting.
Loss of height if multiple vertebrae are affected.
Stooped or curved posture (“dowager’s hump”).
Pain localized to the level of fracture.
Can present as acute or chronic pain [5].
Evaluation and Diagnosis
Clinical Examination – Neurological assessment to rule out spinal cord involvement.
X-ray (Radiograph) – First-line test; lateral view more useful. Compression fracture suspected if anterior vertebral height is reduced by >20% or >4 mm.
CT Scan – Gold standard; provides 3D details of fracture.
MRI – Assesses spinal cord, ligaments, and soft tissue damage.
DEXA Scan – Not diagnostic for fractures but essential to detect osteoporosis and prevent future fractures [6].
Management
Conservative Treatment
Pain management with NSAIDs, opioids, or neuropathic agents.
Use of topical patches or nerve blocks.
Bed rest and spinal support.
Best for stable fractures without neurological deficit.
Surgical Treatment
Required in unstable fractures or those with neurological deficits.
Common procedures: pedicle screw fixation, vertebroplasty, or kyphoplasty [7].
Case Study
A 56-year-old male presented with back pain following a ground-level fall. He had no comorbid conditions.
Examination: Tenderness at L2 level, no neurological deficit.
X-ray: L2 vertebra showed significant anterior height loss.
Image 1. Lateral X-ray of the lumbar spine showing an L2 vertebral compression fracture with loss of anterior vertebral height, marked by a red arrow. CT Scan: Confirmed L2 vertebral fracture.
Image 2. Axial CT scan images of the lumbar spine showing an L2 vertebral fracture with collapse and irregularity of the vertebral body, indicated by red arrows. 
Image 3. CT scan of the lumbar spine in sagittal and coronal views showing an L2 vertebral compression fracture with anterior height loss, highlighted by red arrows.
The patient was advised neurosurgical management. He underwent D12–L1–L3–L4 pedicle screw fixation. Post-surgery, the patient recovered well and returned to daily activities.
Conclusion
Vertebral fractures are a significant health concern, especially in older adults and those with osteoporosis. Early recognition, proper evaluation, and timely treatment are essential to prevent long-term complications such as chronic pain, spinal deformity, or paralysis.
Preventive strategies such as osteoporosis screening, calcium and vitamin D supplementation, lifestyle modification, and fall prevention play a crucial role in reducing fracture risk. Through timely diagnosis and appropriate management—whether conservative or surgical—patients can regain mobility and improve their quality of life.
References
1. Whitney, E., Alastra, A.J.: Vertebral Fracture. In: StatPearls. StatPearls Publishing, Treasure Island (FL) (2025)
2. Oh, H.J., Ryu, K.H., Park, B.J., Yoon, B.-H.: Osteoporosis and Osteoporotic Fractures in Gastrointestinal Disease. J Bone Metab. 25, 213–217 (2018). https://doi.org/10.11005/jbm.2018.25.4.213
3. What Is a Compression Fracture?, https://my.clevelandclinic.org/health/diseases/21950-compression-fractures
4. Symptoms of Spinal Compression Fractures, https://www.webmd.com/osteoporosis/spinal-compression-fractures-symptoms
5. McCARTHY, J., Davis, A.: Diagnosis and Management of Vertebral Compression Fractures. afp. 94, 44–50 (2016)
6. Wong, C.C., McGirt, M.J.: Vertebral compression fractures: a review of current management and multimodal therapy. JMDH. 6, 205–214 (2013). https://doi.org/10.2147/JMDH.S31659
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