December 18, 2018 3:17 pm

• Compression fractures are a common cause of back pain
• Healthy patients heal on their own with a brace
• People with osteoporosis may need cement injection to stabilize the fracture
• We can expect Carson Wentz to do well and return as exciting as ever next Season

The NFL Network today reported that Carson Wentz, who’s been struggling with back pain, actually has a “fractured back.”
I’m not his doctor, and I don’t know any of the true details of his condition. However, based on the press, we can assume Carson Wentz has a compression
fracture of one of the spinal bones. Compression fractures are common. Out of 100 people with back pain, four will turn out to have a compression fracture. The fracture is of the square part of the spinal bone, called the vertebral body.

Many compression fractures happen as a result of injuries like car accidents, falls, and being mugged by a 300 lb. defensive tackle. But you don’t have to be in an accident to get a compression fracture: people with osteoporosis —thinning of the bones— can suffer compression fractures through everyday activities. A rare type of tumor called myeloma, infection of the spinal bones, and even cancer can also show up as back pain with compression fracture.

Doctors can figure out you have a compression fracture by doing a simple x-ray. MRI and CT scans of the spine can be done but are often not needed. The spinal vertebral bones are normally rectangles. It’s called a compression fracture because part of the square bone is compressed.

Most compression fractures hurt, but they’re not dangerous. In rare cases the bones are broken so badly they cannot protect the spinal cord and nerves and are called “unstable fractures.” Pain shooting down the legs like electricity, any numbness or weakness in the legs or arms, trouble peeing after a fall, unexplained weight loss, or chills with back pain should result in a trip to the emergency room for urgent evaluation by a doctor. Pick a hospital that is a “trauma center” for the evaluation to be sure they have the doctors and equipment you need.

The first step in treatment of a compression fracture is bracing and rest. A “corset” brace is worn like a girdle for 3-6 weeks before x-rays are repeated. The right brace depends on which bone is broken. If you have a compression of the L3, L4 or L5 bones then a lumbar support orthosis s the right brace; if it’s one of the Thoracic bones, or the L1, or L3, then a Thoracolumbar Support Orthosis (TLSO) brace would be better. People with osteoporosis don’t have normal bone healing. As a result, the pain is not controlled in the brace, or the pain is still present despite a good trial of bracing, then it’s time to consider cement.

By injecting liquid cement into the fracture and allowing it to harden the fracture is stabilized and stops hutting. The cement is injected through a needle placed under x-rays guidance. Some doctors try to reduce the compression of the vertebral body by blowing up a small balloon in the facture, then injecting the cement. That’s called kyphoplasty. You can see a little graphic of the procedure here:

Carson Wentz is a 25-year-old otherwise apparently healthy athlete. His compression fracture will almost certainly heal in a brace without needing cement, which really is mainly done in people with osteoporosis. The usual time for healing is 6 – 12 weeks. Again, I don’t know the specifics, but if he were my patient Carson would be certainly be done with football this year. But we can expect him to come roaring back next year, fully healed, and as fun to watch as ever.

If you have a compression fracture and are concerned you may need treatment, you can reach me at dan@phxspine.com.
Dan Lieberman, MD