Question
My son had a hard fall on a boat resulting in a compression fracture of the 4, 5 and 8th vertebra in his upper back. The 4 and 5 is 10% and the 8th is 20%. He has no loss of strength and 1 day after this occurred has very little to know pain. He has has no limitation from doing anything. He has been told by the doctor to rest for about 8 weeks. What are your thoughts? Can he make this injury worse by being active. Is there any long term effects. He is 11 years old

Answer
Dear Mike,

He absolutely needs to be restricting his activity...Avoid anything that jars, twists or puts pressure on the spine. This includes
(but is not limited to) heavy lifting, jumping, diving, riding horses, all-terrain vehicles, or motorcycles and most amusement part rides. People with weak spines should also avoid sliding down a slide, jumping from a swing and sledding.

How is this kind of fracture treated?
It can take two or three months for this type of fracture to heal, and most patients do not require surgical interventions. The goal of treatment is to encourage healing, keep the spine stable, restore function and reduce or eliminate pain. Doctors normally recommend starting with:

1.  Limited bed rest
2.  Pain medicines ?often a mix of over the counter and prescription drugs
3.  Activity modifications: no lifting, bending, or twisting
4.  Gradual return to activities

When healing is delayed or pain is difficult to manage a soft or rigid brace or back support may be prescribed. These must be carefully fitted and monitored to avoid putting pressure on the ribs
that can cause new fractures. Whether a surgical procedure is an appropriate treatment for those with slow healing compression fractures can only be decided on a case-by-case basis.

The areas where the spine has been compressed 10% are probably not a big deal in the long term, however, 20% compression could become a problem in the long run.  You may wish to ask your doctor about the vertebroplasty or kyphoplasty procedures which are utilized to reduce pain and regain lost height of the fractured vertebra, however, it is unlikely they will want to perform them if the pain is minimal and the loss of height is small.

Long term prognosis for compression fractures is good with most patients healing completely and regaining all lost function.  The only long term effect that your son may have is an increased kyphosis (stooping forward appearance, increased curvature) of the spine which may or may not affect his posture.  He will likely heal without problems. Hope this helps.

Respectfully,
Dr. J. Shawn Leatherman
www.suncoasthealthcare.net