Diagnosing Spine Compression Fractures

Specialists at NYU Langone’s Spine Center offer expert diagnosis for spine compression fractures. This type of fracture occurs when one or more vertebrae—the bones that comprise the spine—breaks and collapses. Most of the time, the anterior, or front part, of the vertebra is what fractures and collapses. Typically, the rear part of the bone remains intact.

Compression fractures are most frequently diagnosed in the middle part of the back, called the thoracic spine, or in the lower back, called the lumbar spine. 

Most compression fractures occur after a strain, a fall, or another accident that puts stress on the back. Others happen gradually as a result of microfractures in a vertebra. This is most common in people who have osteoporosis, a condition that causes bones to become weak and more likely to break. Over time, the tiny fractures accumulate and flatten, or compress, the vertebra. This type of slow-moving spine fracture most often affects women after menopause.

Spine fractures can be painful, but those that develop gradually may cause no symptoms at first. Some people realize they have a compression fracture only when it’s detected by an X-ray performed for another reason.

If the fracture progresses, a person may experience dull back pain that gets worse during movement. Compression fractures that occur in multiple vertebrae may lead to noticeable changes in the anatomy of the spine, such as a loss of height or increasingly stooped posture, called kyphosis. 

Osteoporosis increases a person’s risk of breaking a vertebra in an injury such as a fall. Because bones are fragile, even a minor incident—for example, falling from a chair—may result in a fracture.

People of any age, even those without osteoporosis, may sustain a compression fracture suddenly as a result of a traumatic injury, such as a car crash. A sharp, severe pain in the back that doesn’t go away, even when resting, may be the first symptom. If a back injury has compressed or damaged a nearby nerve, pain may radiate down the legs. 

NYU Langone doctors encourage you to seek immediate medical attention if you are injured and experience severe, persistent pain.

Rarely, a spine compression fracture may be caused by a tumor that spreads to the vertebrae or an infection that spreads to the spine through the bloodstream.

Our doctors use the results of a medical history, physical examination, and diagnostic imaging tests to help determine whether a compression fracture is causing your back pain. They can also conduct a bone density test, a painless procedure that can determine whether osteoporosis has contributed to a spine fracture.

Medical History

In making a diagnosis, a doctor may ask you when your back pain began and whether it developed suddenly or gradually over time. The doctor may ask what part of your spine hurts the most and whether parts of the spine are tender to the touch.

Your doctor also asks about your overall health and whether you’re being treated for other medical conditions. Certain medications, including diuretics and medications used to treat gastrointestinal disease, may deplete bones of calcium and cause them to become fragile. 

Physical Exam

A doctor conducts a thorough physical exam of the spine, which can reveal any physical changes that indicate a compression fracture. Sometimes, a spine compression fracture produces a visible protrusion or bulge at the site of the vertebral collapse. It can also cause the spine to shorten or bend forward. A significantly compressed spine may lead to kyphosis, which is usually the result of a series of compression fractures over months or years.

If you experience pain that radiates down the legs, a doctor may conduct a neurologic examination to test your muscle and reflex strength in determining whether a fracture has compressed a nerve.

You may have no signs or symptoms, other than persistent back pain. Symptoms can sometimes appear months or years after a compression fracture occurs, as the spine starts to degenerate as a natural part of aging. 

Imaging Tests

Doctors use a variety of imaging technologies to obtain detailed pictures of the spine and the surrounding nerves and soft tissues. These images help doctors determine the location and severity of a spine compression fracture. They can also estimate when it happened.

X-rays

X-rays use low doses of radiation to create images of the spine, allowing doctors to take a close look at vertebrae.

An X-ray can reveal changes in the size and shape of a spinal bone. For instance, an atypically short vertebra may indicate that a spine compression fracture has healed in its compressed position. 

Subsequent X-rays don’t help doctors assess whether the fracture has healed but may help them see if further compression is occurring. 

CT Scans

If an X-ray image reveals a spine compression fracture and a doctor needs to see the spine in more detail, he or she may recommend a CT scan. CT scans use a series of X-rays to create two- and three-dimensional images of the spine so that doctors can examine the fractured bone from many angles.

A CT scan may be helpful if a fracture was caused by a traumatic injury and doctors want to analyze the fracture pattern. Doctors may use a CT scan to assess if the cracks expand through the entire vertebra or affect just a small part of the bone. 

MRI Scans

An MRI scan uses magnetic fields to create computer-generated images of the inside of the body. It’s especially helpful if doctors need to distinguish between a fracture that is actively healing and an older fracture that has not healed.

MRI scans can provide detailed images of nerves located near the spine and may help a doctor confirm a pinched nerve caused by a compression fracture. MRI imaging may also reveal the presence of a tumor or infection near the spine.

Bone Scans

Your doctor may recommend a bone scan to determine whether a compression fracture is actively healing or an old injury.

In this test, a technician injects a small amount of radioactive dye into a vein in your arm. This dye, called a tracer, travels through the bloodstream and accumulates in places where your cells and tissues are most actively working to make repairs. 

After the tracer has had one or two hours to move through the bloodstream, a radiologist scans your body using a special camera that captures images of the tracer. The images show activity at the fracture site that indicates whether the body is working to heal the fracture. Areas that absorb more of the tracer are called “hot” spots. A “hot” bone scan typically suggests your fracture is still in the process of healing.

Bone Density Test 

A bone density test, also called a DEXA, or dual-energy X-ray absorptiometry, scan, takes a series of X-rays, usually of your lower spine and hips, in order to determine the amount of calcium and other minerals present in your bones.

DEXA scans assess the density or quality of the bones. The images are processed and converted into a numeric value. This is used to compare your bones to the bones of other people your age and to young, healthy people. 

It’s important for your doctor to identify if you have low bone density, because weakened bones may affect your treatment options for a fracture. If scans indicate low density, our doctors work closely with NYU Langone endocrinologists, specialists who can provide medication and continued monitoring for people with low bone density. They often schedule follow-up visits and DEXA scans every other year.