
A vertebral compression fracture is a collapse in the height of a vertebral body, so it loses its normal shape. The commonest form occurs in older adults on a background of osteoporosis, where the fracture follows a minor fall, a lift, or even an ordinary movement. The patient reports sudden severe back pain that worsens on moving and getting out of bed and eases on lying down, and with multiple fractures height may be lost and the upper back becomes more rounded. In younger people, fractures usually follow high-energy trauma such as a road accident or a fall from height, and some fractures are pathological, caused by a tumour or bone infection. Assessment answers three questions on which the whole plan rests: is the fracture recent or old and already healed, is it stable or unstable, and what caused it. Plain X-rays are used, MRI to distinguish a recent fracture and to assess soft tissue and nerves, and CT to detail bone anatomy, along with blood tests and bone density measurement to diagnose osteoporosis or to look for another cause behind the fracture. Most stable osteoporotic compression fractures heal with non-surgical care: pain control with medication prescribed by the doctor, early graded mobilisation instead of prolonged bed rest that weakens muscle and bone, a brace for a limited period in selected cases, physiotherapy for back strength and balance, and most importantly starting osteoporosis treatment, ensuring adequate calcium and vitamin D, and reducing fall risk at home. When severe disabling pain persists despite this, vertebral augmentation with image-guided bone cement is considered. Unstable fractures, or fractures with nerve compression, need surgical stabilisation and sometimes decompression of the canal. The limits are explicit. Cement augmentation aims to relieve pain and stabilise the fracture; it does not treat osteoporosis and does not prevent a fracture at another vertebra — what reduces that risk is treating the osteoporosis itself and preventing falls. A brace supports the back and eases pain but does not restore vertebral height, and wearing it for a long time without exercise weakens the trunk muscles. An old healed fracture gains nothing from augmentation, which is why the fracture must be shown to be recent before the procedure. Which option suits you is determined by clinical examination and appropriate imaging rather than by reading a page, and new back pain in someone with osteoporosis deserves assessment and should not be dismissed as a muscle strain.
Procedure steps
- 1
Clinical assessment and locating the level
The doctor asks when the pain began and whether it followed a fall or effort, palpates the vertebrae to identify the painful level, examines power, sensation, reflexes and gait, measures height against what you recall, and asks about previous fractures and steroid use.
- 2
Imaging and identifying a recent fracture
X-rays show the loss of vertebral height, MRI distinguishes a recent from an old fracture and reveals nerve compression, a mass or infection, and CT clarifies the bone anatomy and whether the fracture extends into the posterior wall, which determines stability.
- 3
Finding the cause and assessing the bone
Blood tests and bone density measurement are requested to diagnose osteoporosis, vitamin D deficiency or diseases affecting bone, and tumour or infection is investigated when there is fever, weight loss, night pain or a history of cancer. Identifying the cause is what prevents the next fracture.
- 4
Structured non-surgical care
Pain control with prescribed medication alongside early graded standing and walking, a brace for a limited period in selected cases, physiotherapy for back strength and balance, starting osteoporosis treatment with adequate calcium and vitamin D, and adapting the home to reduce falls.
- 5
Vertebral augmentation or surgical fixation
When severe pain persists with a recent fracture confirmed on MRI, bone cement is injected into the vertebral body through a needle under image guidance with local or light anaesthesia. For unstable fractures or nerve compression, stabilisation with screws and rods is performed, with canal decompression when needed, followed by rehabilitation and follow-up.
Before the procedure
Tell the doctor exactly how the pain began — after a fall, after lifting, or with no cause at all — because this detail directs the diagnosis. Bring all imaging and reports and any calcium and vitamin D results, plus a complete list of your medicines, especially long-term steroids, blood thinners and any previous osteoporosis treatment. Mention old fractures even if they seemed trivial, and any history of cancer, infection, weight loss or fever. If vertebral augmentation is planned, ask about fasting and which medicines to stop beforehand, and arrange for someone to drive you and stay with you afterwards. Prepare your home before you return: add night lighting, remove loose rugs, fit grab rails in the bathroom, and arrange help for the first few days.
After the procedure
Get up and take short frequent walks from the outset within the limits of pain, because prolonged bed rest weakens muscle and bone and raises the risk of clots and chest infection. Use the brace only for the prescribed period, and begin back-strengthening and balance work with a physiotherapist. Continue osteoporosis treatment, calcium and vitamin D exactly as prescribed and do not stop once the pain settles, because that is what prevents the next fracture. Review medicines that make you dizzy, have your vision checked, remove fall hazards at home, and wear stable footwear. **Go to the emergency department immediately for progressive leg weakness, numbness between the thighs and around the anus, urinary retention or leakage of urine or stool — these are cauda equina symptoms and are a surgical emergency — and likewise for shortness of breath or chest pain after an augmentation procedure.** Contact your doctor quickly for sudden new back pain suggesting a fracture at another vertebra, fever and chills, increasing night pain, or unintended weight loss.
Expected duration
An assessment visit usually takes 20 to 40 minutes, a stable fracture usually unites over 6 to 12 weeks, and a vertebral augmentation procedure usually takes 30 to 60 minutes.
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