A vertebral fracture is a break, crack or collapse of one or more of the bones (vertebrae) in the spinal column. These fractures may occur as a result of high-energy trauma, such as a vehicle collision or fall from height, or from weakened bones in low-energy events, such as in osteoporosis. Disruption of the vertebra may alter spinal alignment, compromise structural support, impair nerve or spinal cord function, and lead to pain, loss of mobility or deformity.

Anatomy and Biomechanics

The spine consists of a series of vertebrae separated by intervertebral discs, supported by ligaments, muscles and surrounding soft tissues. Each vertebra bears axial load and contributes to motion and stability of the spine. When a vertebra fractures—whether by compression, burst, distraction or dislocation—the normal load-bearing capacity and alignment can be disrupted. Collapse of a vertebra changes the spinal mechanics, may increase local curvature (kyphosis), and can overload adjacent segments. The presence of nerve roots, spinal cord and blood vessels in close proximity also means fractures may lead to neurological compromise or vascular injury if the structure is disturbed.

Etiology and Risk Factors

Mechanisms of Injury

Vertebral fractures may result from a high-energy mechanism (motor vehicle accident, fall from height, sports trauma) or from low-energy mechanisms when bone strength is compromised (such as in osteoporosis, tumors, or metabolic bone disease). In low-energy cases, the fracture may occur during routine activities like bending forward, coughing, or lifting.

Risk Factors

• Advanced age and reduced bone mineral density
• Osteoporosis, osteopenia, or other metabolic bone disorders
• Tumour involvement of vertebrae or metastatic disease
• Previous history of vertebral fracture
• High-risk environments or activities (falls, contact sports, heavy lifting)
• Corticosteroid use, smoking, or other factors impairing bone quality

Classification and Fracture Patterns

Vertebral fractures vary in terms of location (cervical, thoracic, lumbar), pattern (compression, burst, flexion-distraction, dislocation), stability, and involvement of spinal canal or neural elements. Examples of common patterns include:

• Compression fracture (anterior portion of the vertebra collapses)
• Burst fracture (vertebra breaks in multiple parts and may impinge on the spinal canal)
• Flexion-distraction (vertebrae pulled apart, often in seat-belt injuries)
• Fracture-dislocation (vertebra shifts relative to adjacent level, highly unstable)
  The pattern influences treatment decisions and prognosis. Stable fractures without neural compromise may be managed non-operatively, while unstable injuries or those involving the spinal cord often require surgical intervention.

Clinical Presentation

Symptoms

Patients may present with sudden back or neck pain following trauma in high-energy cases, or an insidious onset of pain in cases of fragility fracture. Pain may be localised to the fracture level, aggravated by standing, sitting, or motion, and relieved by lying down. Neurological symptoms such as numbness, tingling, weakness, loss of bowel or bladder control may occur when nerve roots or the spinal cord are involved.

Physical Examination

On examination, the spine may show tenderness at the affected level, reduced motion, a change in posture (such as increased kyphosis), palpable deformity in severe cases, and neurological deficits. A thorough neurovascular assessment and evaluation of adjacent levels is important.

Diagnostic Evaluation

Imaging

Initial evaluation often includes plain radiographs of the appropriate spine region (lateral and AP views) to detect fractures, vertebral height loss, and alignment changes. CT scanning is valuable for delineating fracture morphology, canal compromise, and alignment, especially in burst or dislocation patterns. MRI may be used to assess soft-tissue injury, spinal cord or nerve root compromise, and to determine the age of fracture in ambiguous cases.

Additional Studies

Bone density testing may be relevant in fragility fractures to assess osteoporosis. If a tumour is suspected, additional imaging or biopsy may be necessary to identify the underlying pathology.

Treatment

The goal of treatment is to relieve pain, restore or maintain spinal stability and alignment, protect the neural elements, support healing, and maximise functional recovery.

Non-operative Management

In selected stable fractures without neural compromise, nonoperative care may include analgesia, bracing to support the spine, activity modification, physical therapy focusing on core and back strengthening, and correction of bone-health issues. Monitoring of alignment and progression is essential.

Surgical Management

Surgery is indicated in unstable fractures, those with significant vertebral collapse, dislocation, canal compromise, or neurologic injury. Surgical options may include vertebral body reconstruction, instrumentation, fusion of affected levels, decompression of neural elements, or minimally invasive techniques such as vertebroplasty/kyphoplasty in compression fractures. A multidisciplinary approach is often required, given the complexity of spinal injury.

Rehabilitation and Follow-Up

Rehabilitation begins once the patient is stable and may include gentle mobilization, progression of movement and strengthening exercises, posture correction, and gradual return to activity. Long-term follow-up is needed to monitor for complications such as progressive deformity, adjacent-segment disease, or chronic pain. Bone health optimisation (nutrition, medication, lifestyle) is an integral part of care, especially in fragility fractures.

Complications and Prognosis

Potential complications include persistent or increased spinal deformity (kyphosis), chronic pain, non-union or delayed healing, nerve or spinal cord injury with persistent neurologic deficits, adjacent vertebral fractures, and reduced quality of life. Prognosis depends on the fracture pattern, bone quality, presence of neurologic injury, timely and appropriate treatment, and overall patient health. In many cases early intervention and rehabilitation lead to good outcomes; however, in unstable or complicated fractures, residual disability or further fractures may occur.

Prevention and Patient Education

Prevention focuses on fall-prevention strategies, maintaining bone health through adequate calcium and vitamin D, screening for osteoporosis in at-risk individuals, avoidance of high-risk behaviours, and prompt evaluation after trauma. Patients should be taught to recognise early signs of back pain or height loss, report new symptoms, follow bone-health strategies and participate in appropriate low-impact exercise programmes to maintain spinal strength and stability.

References

Zhang, Y. K., Wang, J. X., Ge, Y. Z., Wang, Z. B., Zhang, Z. G., Zhang, Z. W., & Chang, F. (2025). The global burden of vertebral fractures caused by falls among individuals aged 55 and older, 1990 to 2021. PloS one, 20(4), e0318494.

Zheng, W., Huang, J., Jin, L., Zhang, Q., Li, T., Gong, W., … & Wang, L. (2025). Risk factors for subsequent vertebral fractures after percutaneous vertebral augmentation in Asian populations: a systematic review and meta-analysis. BMC Musculoskeletal Disorders, 26(1), 791.

Daskalakis, I. I., Bastian, J. D., Mavrogenis, A. F., & Tosounidis, T. H. (2025). Osteoporotic vertebral fractures: an update. SICOT-J, 11, 40.