A vertebral compression fracture (VCF) occurs when a bone in the spine collapses, causing it to become shorter, often in a wedge shape. This collapse typically affects the thoracic and lumbar regions and leads to severe back pain. The primary cause of VCFs is osteoporosis, which weakens bone density, making the vertebrae susceptible to fracture from minimal stress. Trauma or tumors that weaken the bone structure are also potential causes. Managing a VCF requires a coordinated approach involving several medical specialists to ensure stability and functional recovery.
Initial Diagnosis and Referral
The first point of contact for sudden, severe back pain suggesting a VCF is often an Emergency Room (ER) physician or a Primary Care Physician (PCP). These doctors perform the initial physical examination and order diagnostic imaging to confirm the fracture. Standard X-rays of the spine are typically the first step, revealing the characteristic loss of vertebral height or a wedge deformity.
If the initial X-ray confirms a fracture, or if symptoms suggest nerve involvement, a Computed Tomography (CT) scan or Magnetic Resonance Imaging (MRI) may be ordered. These advanced imaging techniques help determine the stability of the fracture and whether bone fragments are pressing on the spinal cord or nerve roots. Once the diagnosis is confirmed, the PCP or ER doctor coordinates a referral to a spine specialist for definitive treatment planning.
Surgical and Minimally Invasive Specialists
Physicians focused on stabilizing the fractured vertebra are central to VCF care, especially when conservative treatment fails to control pain. This group includes surgeons and interventional pain specialists who use distinct techniques to address the collapsed bone structure. Orthopedic surgeons and neurosurgeons handle the most complex or unstable VCFs.
These surgeons may perform traditional open surgery, such as spinal fusion, when the fracture is severely unstable or has caused significant neurological deficit. Spinal fusion permanently joins two or more vertebrae to stabilize the spine, though this is less common for simple osteoporotic VCFs. Their expertise is necessary for complex stabilization in cases involving tumor removal or severe trauma.
Minimally invasive procedures, such as vertebroplasty and kyphoplasty, are performed by interventional radiologists, pain management specialists, or fellowship-trained surgeons. Both procedures involve injecting specialized bone cement directly into the fractured vertebra for stabilization. In vertebroplasty, cement is injected under fluoroscopic guidance to reinforce the collapsed bone.
Kyphoplasty includes an additional step where a balloon-like device is inserted and inflated within the fractured vertebra to partially restore its height before the cement is injected. These outpatient procedures are highly effective for pain relief by stabilizing the fracture site. All specialists utilize imaging guidance to perform the precise cement injection.
Non-Surgical Management and Rehabilitation
A significant portion of VCF treatment focuses on non-operative management and the restoration of function, coordinated by a physiatrist. Physiatrists specialize in treating injuries that affect movement and function, leading the multidisciplinary rehabilitation team. They design comprehensive non-operative treatment plans, which may include prescribing custom back braces to limit spinal movement and allow the fracture to heal.
The physiatrist works with physical therapists to develop tailored exercise programs focusing on strengthening core muscles, improving posture, and increasing overall mobility. They also manage medications and coordinate care with other specialists to maximize the patient’s functional independence and quality of life. Rehabilitation is a long-term undertaking that helps prevent future fractures by addressing underlying muscle weakness and balance issues.
Pain management specialists, often anesthesiologists or neurologists with subspecialty training, manage persistent pain that does not respond to initial medication. They administer targeted pain relief through nerve blocks or epidural steroid injections to manage nerve-related pain associated with the fracture. Their focus is alleviating discomfort to facilitate engagement in physical therapy and rehabilitation.