Vertebral fractures
Compression fractures — Osteoporotic collapse & traumatic fractures
What is a vertebral fracture?
A vertebral fracture is a break in the bony structure of a vertebra. It may result from violent trauma (a fall, a road accident) in a younger person, or occur after minimal effort — even spontaneously — in an older individual whose bones have been weakened by osteoporosis. This is known as a "compression fracture".
The osteoporotic compression fracture is the most common form: the vertebra crushes down on itself, "collapsing" like a wet sugar cube. It is a major public health problem, often under-diagnosed because the pain is sometimes attributed to a "simple backache".
Types of fractures
Vertebral fractures are classified according to their mechanism and severity:
• Compression (wedge) fracture: the vertebra loses height, usually with the front edge collapsing more — the most common form in osteoporosis
• Burst fracture: the vertebra shatters in all directions, with a risk of fragments being pushed into the canal and compressing the nerves
• Fracture-dislocation: a fracture with vertebral displacement — a severe, often unstable form, common in high-energy trauma
• Pars fracture: fracture of a specific area of the vertebra (see spondylolisthesis)
Symptoms & Clinical signs
• Acute pain: sudden onset of a "band-like" pain in the back, often triggered by a false movement, an effort or a fall
• Functional impairment: the patient struggles to stand, walk, or turn in bed — every movement is painful
• Loss of height: successive compression fractures cause progressive "shortening" of the spine and a hunched posture (kyphosis)
• Neurological signs: leg weakness, urinary problems — these signal cord or nerve compression and constitute an emergency
• Silent form: some osteoporotic fractures go unnoticed and are only discovered on X-ray
Diagnosis
• X-rays: the first investigation to perform — they show the fracture, its location and spinal alignment
• CT scan (gold standard in emergency): provides a precise map of the fracture, assesses stability and fragment displacement into the canal
• MRI: distinguishes a recent fracture from an old one (a crucial difference for treatment decisions) and detects nerve compression
• Bone densitometry (DEXA scan): in osteoporotic fractures, it measures bone density and guides preventive treatment against further fractures
Treatment
Treatment depends on the stability of the fracture, the level of pain and the presence of neurological complications:
Conservative treatment
• Initial rest and strong painkillers to control acute pain
• Brace: temporary spinal support during the healing period (approximately 6 to 12 weeks)
• Progressive rehabilitation with physiotherapy once the painful phase has passed
• Osteoporosis treatment: essential to prevent further fractures (calcium, vitamin D, specific medications)
Surgical treatment
• Cement augmentation (vertebroplasty / kyphoplasty): percutaneous injection of bone cement into the fractured vertebra under local anaesthesia — often providing dramatic pain relief within hours
• Instrumented fixation: stabilisation with screws and rods for unstable fractures or neurological compromise
• Surgical decompression: performed as an emergency if bone fragments are compressing the spinal cord or nerves
Key figures
1.4 million
Vertebral fractures per year worldwide (osteoporosis)
50%
Risk of a new fracture if osteoporosis is left untreated
Two thirds
Of compression fractures are not diagnosed at the time they occur
Recovery after treatment
After cement augmentation (vertebroplasty or kyphoplasty), pain relief is often dramatic: the pain decreases significantly within hours of the procedure. The patient can stand and walk on the same day. Discharge is usually the same day or the next morning. Daily activities are gradually resumed over a few days, with no brace required in most cases.
After instrumented fixation (screws and rods), the hospital stay averages 5 to 10 days. A rigid brace is prescribed for 6 to 12 weeks depending on the fracture. Early mobilisation is encouraged within the first few postoperative days. A rehabilitation programme begins after the immobilisation phase, focusing on trunk muscle strengthening, mobility recovery and fall prevention. Bone healing is monitored with regular X-rays. A full return to independence typically occurs between 3 and 6 months.
Consultation with Dr Dimitriu
Dr Christian Dimitriu, a neurosurgeon specialising in spine surgery, manages vertebral fractures in all their forms — osteoporotic compression fractures, traumatic fractures and pathological fractures. During the consultation, he performs a thorough clinical examination and reviews all imaging (X-rays, CT scan, MRI) to determine the nature of the fracture, how recent it is and its stability.
MRI is particularly important for distinguishing a recent ("active") fracture from an old, already healed one — a crucial distinction for guiding treatment. When cement augmentation is indicated, Dr Dimitriu explains the procedure and expected results in detail. For unstable fractures or those with neurological compromise, he discusses the various surgical options and the postoperative follow-up plan. He also coordinates osteoporosis management with the patient's GP to prevent further fractures.
Prevention
Preventing vertebral fractures primarily relies on screening for and treating osteoporosis. Bone densitometry (DEXA scan) is recommended for all post-menopausal women and for any patient with risk factors (prolonged corticosteroid use, previous fracture, smoking). Adequate intake of calcium (1,000 to 1,200 mg/day) and vitamin D (800 to 1,000 IU/day) is essential, supplemented if necessary by specific osteoporosis medication.
Regular weight-bearing exercise (walking, stair climbing, resistance training) stimulates bone formation and maintains density. Fall prevention is crucial in older adults: home modifications (lighting, rugs, grab bars), vision correction, balance exercises and review of medications that may increase fall risk (sleeping pills, antihypertensives).
Consultations in Île-de-France
Dr Dimitriu practises at 4 facilities in the Paris region (Île-de-France), easily accessible from central Paris: Clinique de l'Yvette (Longjumeau), Hôpital Privé d'Antony, Clinique du Mont-Louis (Les Lilas) and Hôpital Privé de l'Ouest Parisien (Saint-Cloud). See addresses and book an appointment.
Frequently asked questions
No, vertebroplasty is performed under local anaesthesia, sometimes with light sedation. The procedure is percutaneous (through the skin, without an incision) and takes approximately 30 to 45 minutes. Pain relief is often dramatic within hours. Patients can usually go home the same day or the following day.
A brace is typically worn for 6 to 12 weeks depending on the type of fracture and its location. The brace keeps the spine in the correct position while the bone heals. The doctor adjusts the duration based on follow-up X-rays and clinical progress. Rehabilitation begins gradually, often before the brace is finally removed.
Prevention relies on screening for osteoporosis with bone densitometry (DEXA scan), adequate calcium and vitamin D intake, specific osteoporosis treatment if needed, and regular weight-bearing exercise (walking, resistance training). Fall prevention (home modifications, balance training) is also essential in older adults.
Yes, in the vast majority of cases. Compression fractures without neurological damage heal well, and patients gradually resume walking and their usual activities. After vertebroplasty, walking is resumed on the day of the procedure. Even after more extensive surgery (instrumented fixation), rehabilitation usually allows a full return to independence.
Sources: IOF (International Osteoporosis Foundation) · GRIO · The Lancet (Clark & Tobias, 2020).