Compression Fracture of the Lumbar Vertebra: Causes, Symptoms, and Treatment

A compression fracture of the lumbar spine occurs more often than a similar injury in the thoracic spine. However, the causes, mechanism, and treatment principles are the same for both.

Neurologists, traumatologists, neurosurgeons, and general surgeons all encounter this injury. Recognising it can be difficult, especially when the patient does not recall any fall.

Causes of Compression Fracture

A compression fracture is an injury in which a vertebra is compressed, losing its height. The typical mechanism: $compression fracture$

Falling from one’s own height onto the buttocks.
Sometimes the person does not even pay attention — falls, gets up, and walks on.
Pain may not appear immediately but days or weeks later.

Falls from a small height usually do not cause serious complications. However, falls from the second floor or higher significantly increase the risk of spinal cord compression, nerve root damage by bone fragments, and entrapment of nerve structures.

Non-obvious cases: fracture without trauma

Sometimes a compression fracture occurs without any obvious trauma. I observed a patient (the grandson of writer Alexei Tolstoy) who was treated unsuccessfully for back pain for a long time. No method helped. A CT scan revealed a compression fracture of the spine — with no trauma in his history.

The cause was osteoporosis — reduced bone density. It was enough to sit down in a chair slightly harder than usual for the vertebra to break.

Important: with osteoporosis, even a spontaneous compression fracture of the lumbar spine is possible.

Symptoms of Compression Fracture

Suspect the injury if you notice:

Back pain — acute at the moment of injury, then aching and constant.
Increased pain with movement, bending, trying to sit or stand up.
Limited mobility in the lumbar or thoracic spine.
Muscle tension in the back — reflex spasm.
Postural changes — increased kyphosis (stooping).
Neurological symptoms — numbness, weakness in the legs, sensory disturbances (in complicated fractures).

Doctor’s tip: remember compression fracture when you encounter atypical radiculitis and long-lasting pain that does not respond to treatment.

Diagnosis

To confirm the diagnosis:

X-ray of the spine (two views).
CT scan — the most accurate method for assessing compression degree.
MRI — if spinal cord or nerve root damage is suspected.
Densitometry — to assess bone density (if osteoporosis is suspected).

Treatment of Lumbar Compression Fracture

Uncomplicated fractures

Treatment is relatively simple but requires strict adherence:

Bed rest — from 6 to 8 weeks.
If one vertebra is damaged without complications — 6 weeks is usually enough.
Afterwards — wearing an orthosis (brace) to fix the damaged area. Course — about 3 weeks.
Important: if bed rest is not observed, regular pain will develop later, which is difficult to manage.

Complicated fractures

Complicated fractures require more complex treatment:

Assessment of damage — how much the spinal cord and roots are affected.
Surgery — to relieve spinal cord or nerve root compression.
Metal fixation — to stabilise the damaged segment.
Rehabilitation — recovery depends on the severity of spinal cord damage.

Prevention and Recommendations

With osteoporosis — regular bone density monitoring and calcium/vitamin D supplements.
Avoid falls: use non-slip shoes, handrails, good lighting.
For prolonged back pain — do not delay seeing a doctor.
Timely diagnosis prevents severe complications.

Conclusion

A compression fracture of the lumbar vertebra is a serious injury that can occur even without a significant fall, especially with osteoporosis. Early diagnosis and proper treatment (bed rest, orthosis, surgery if needed) help avoid chronic pain and neurological complications.

If you or your loved ones experience long-lasting back pain that does not respond to treatment — be sure to get examined. The cause may be a compression fracture.