A broken back is a fracture in one or more of the bones (vertebrae) that make up your spinal column. It ranges from a small crack in a single vertebra to a catastrophic injury that damages the spinal cord. Roughly 7.5 million vertebral fractures occur worldwide each year, caused by everything from car accidents and falls to the gradual bone thinning of osteoporosis.
Types of Spinal Fractures
Not all broken backs are the same. The type of fracture depends on how force was applied to the spine, and it determines both the severity of the injury and how it’s treated.
Compression fractures are the most common type. The front of a vertebra cracks and collapses while the back stays intact, giving the bone a wedge shape. These can result from a fall or a blow, but they also develop gradually in people with osteoporosis, sometimes from something as minor as coughing, sneezing, or twisting.
Burst fractures happen when a sudden, powerful force crushes a vertebra from all directions, breaking it into multiple pieces. Both the front and back of the bone are damaged. Bone fragments can scatter into the spinal canal, which makes this type more dangerous because of the risk to the spinal cord.
Chance fractures (also called flexion-distraction fractures) are essentially the opposite of a burst fracture. Instead of being crushed together, the vertebrae are violently pulled apart. These often happen in car accidents when the upper body is thrown forward while the lower body is held in place by a seatbelt.
Transverse process fractures affect the small bony wings that project from the sides of each vertebra. They’re caused by extreme rotation or sideways bending and, while painful, are generally less serious than fractures involving the main vertebral body.
What Causes a Broken Back
Spinal fractures fall into two broad categories: traumatic and non-traumatic. Traumatic fractures come from external forces like falls, car crashes, sports collisions, or violence. These are high-energy injuries that can happen to anyone regardless of bone health.
Non-traumatic fractures are tied to underlying conditions, most commonly osteoporosis. As bones lose density, vertebrae weaken and flatten over time. A vertebral compression fracture happens when too much pressure is placed on a bone that’s already fragile. People with advanced osteoporosis can fracture a vertebra during everyday activities like reaching for something on a high shelf or bending to pick up a bag of groceries. Post-menopausal women are at particularly high risk because of the drop in bone density that accompanies menopause. Long-term steroid use and certain metabolic disorders also weaken bones enough to make fractures possible without significant trauma.
Symptoms to Watch For
The most obvious symptom is sudden, severe back pain at the fracture site. With compression fractures from osteoporosis, the pain may come on more gradually or even be mistaken for general back soreness. Pain typically worsens with movement and improves with rest.
The real concern with any spinal fracture is whether the spinal cord or nearby nerves are involved. Warning signs of spinal cord injury include:
- Numbness, tingling, or loss of feeling in your hands, feet, fingers, or toes
- Weakness or loss of control in any part of your body
- Loss of bladder or bowel control
- Trouble breathing after the injury
- Difficulty with balance and walking
- An obviously twisted or misaligned neck or back
Any of these symptoms alongside back pain signals a medical emergency. If you suspect someone has a spinal fracture, keep them still and call for help rather than trying to move them.
How a Broken Back Is Diagnosed
Diagnosis starts with X-rays taken from the front and side. These can reveal loss of vertebral height, widening between the bony structures of the spine, and changes in spinal alignment. However, X-rays miss fractures more than 20% of the time, so a CT scan is often the next step. CT provides detailed images of exactly how the bone is broken, whether fragments have shifted into the spinal canal, and how much the vertebra has collapsed.
An MRI is used when there are signs of nerve or spinal cord involvement, or when doctors suspect damage to the ligaments holding the spine together. Up to 15% of patients with one spinal fracture have injuries at other levels of the spine, so imaging of the entire spinal column is standard practice.
Treatment Without Surgery
Most compression fractures heal without an operation. Treatment typically involves rest, pain management, and a brace (called a TLSO brace) that limits spinal motion while the bone heals. In one study of 447 patients with vertebral compression fractures treated without surgery, fewer than 1% eventually needed a surgical procedure. The risk of the fracture worsening enough to cause nerve damage was similarly low: just 1 patient out of 477.
Interestingly, research has found that the type of brace used, or even whether a brace is used at all, doesn’t significantly change outcomes like pain levels, function, or the chance of needing surgery down the road. The bone heals on its own in most cases, with the brace primarily providing comfort and a sense of stability during recovery.
When Surgery Is Needed
Surgery becomes necessary for unstable fractures, those with bone fragments pressing on the spinal cord, or fractures that don’t respond to conservative treatment. The specific approach depends on the type and location of the break.
For compression fractures that remain painful despite rest and bracing, two minimally invasive procedures are common options. In vertebroplasty, a doctor uses imaging guidance to inject a cement mixture through a hollow needle directly into the fractured bone, stabilizing it. Kyphoplasty takes an extra step: a small balloon is first inflated inside the collapsed vertebra to restore some of its lost height, creating a cavity that’s then filled with cement. Both procedures work best when performed within eight weeks of the fracture. About 75% of patients who undergo vertebroplasty regain lost mobility and return to a more active life.
More severe injuries, like burst fractures or fracture-dislocations, may require spinal fusion, where metal hardware is used to hold the damaged vertebrae in place while bone grafts fuse them together. In cases where bone fragments are pressing on the spinal cord, a procedure called a laminectomy removes the bony arch at the back of the spinal canal to relieve that pressure.
Long-Term Risks of Untreated Fractures
When compression fractures go undiagnosed or untreated, the collapsed vertebrae can permanently change the shape of the spine. In the upper back, wedge-shaped compression fractures cause the spine to curve forward progressively. This forward rounding, called kyphosis, was historically known as “dowager’s hump” because it was so common in older women before routine screening for low bone density became standard.
Kyphosis isn’t just cosmetic. When the curve in one section of the spine becomes disproportionate to the rest, it causes chronic pain, limits mobility, and can eventually compress the chest cavity enough to affect breathing. Each compression fracture also weakens the surrounding vertebrae by shifting more mechanical load onto them, increasing the risk of additional fractures in a cascading pattern. For people with osteoporosis, treating the underlying bone loss is just as important as treating the fracture itself to break this cycle.