Compression Fractures of the Lumbar Spine: Complications & Long-Term Effects

Vertebral compression fractures (VCFs) — often from osteoporosis — have immediate and long-term sequelae.

Immediate Complications

• Severe back pain: Worse with movement/standing; may radiate.
• Neurologic deficits: Rare; if retropulsed fragment compresses cord/cauda equina → weakness, numbness, bowel/bladder dysfunction.

Long-Term Complications

• Chronic pain: Persistent mechanical/neuropathic pain.
• Height loss: Each VCF reduces vertebral height; cumulative → measurable stature loss.
• Kyphosis: Thoracic VCFs → exaggerated thoracic curve (dowager's hump); impairs breathing, balance, increases fall risk.
• Osteoporosis marker: VCF = clinical osteoporosis; 5× risk of subsequent fractures.
• Reduced quality of life: Pain, deformity, fear of falling, social isolation.

Management

• Acute: Analgesia, brief rest, early mobilization, bracing.
• Vertebroplasty/kyphoplasty for refractory pain.
• Osteoporosis treatment: Bisphosphonates, denosumab, anabolics (teriparatide, romosozumab) + calcium/vit D.
• Fall prevention: balance training, home safety, vision check.

Early diagnosis and osteoporosis treatment are critical to prevent the "fracture cascade."