What is a vertebral compression fracture?

A vertebral compression fracture happens when one of the block-shaped bones of the spine partially collapses. This most often affects the thoracic spine in the mid-back or the lumbar spine in the low back, especially around the lower thoracic and upper lumbar junction, such as T12 or L1.

Many people first hear this term after imaging is done for back pain, a fall, osteoporosis, or concern that a spine problem might need surgery. A report may describe height loss, an endplate fracture, marrow edema, or retropulsion. These words can sound alarming, but each has a specific meaning.

This article is general education and is not a diagnosis. Your own results need to be interpreted with your symptoms, exam, medical history, and the official radiology report.

Acute vs old: why the timing matters

Radiologists often try to determine whether a compression fracture is acute, subacute, or chronic. In plain language, that means recent, healing, or older.

This matters because a recent fracture is more likely to explain new focal back pain and may change short-term treatment. An old fracture may be a sign of prior injury or osteoporosis, but it may not be the main cause of today’s pain. Some people have multiple compression deformities, with one recent painful fracture and other older, healed fractures.

How MRI helps show a recent fracture

MRI is especially useful for fracture age because it can show changes inside the bone marrow. A recent or healing fracture often has marrow edema, which means extra fluid-like signal in the injured bone. Reports may mention this on STIR images or other fluid-sensitive MRI sequences.

If a vertebra is collapsed but has little or no marrow edema, it is more likely to be chronic. However, imaging is not always perfectly clear. The radiologist may use terms such as acute-favored, subacute, or age-indeterminate when the appearance is mixed or when prior studies are not available.

How CT helps show the bone structure

CT is excellent for seeing bone detail. It can show the exact shape of the fracture, the endplates, the amount of collapse, and whether a small piece of bone has moved backward toward the spinal canal.

CT may suggest that a fracture is recent when there is a sharp fracture line, new endplate depression, or surrounding features that fit the pain story. But CT does not show marrow edema as well as MRI. That is why a clinician may order MRI after CT if knowing whether the fracture is fresh would change management.

Common report terms explained

Height loss

Height loss means the vertebral body has become shorter because of collapse. Reports may describe mild, moderate, or severe height loss, or they may give a measurement. The collapse can be wedge-shaped, central, or involve the upper or lower endplate.

More height loss can affect posture and spinal alignment, but pain severity does not always match the percentage of collapse. A small recent fracture can hurt a lot, while an old severe compression deformity may be less painful.

Endplate fracture or concavity

The endplates are the top and bottom surfaces of the vertebral body. A report may describe an endplate fracture or endplate concavity when one of these surfaces has caved in. This can occur with trauma, osteoporosis, or sometimes with other bone-weakening conditions.

Marrow edema

Marrow edema is one of the key MRI clues that a fracture is recent or still healing. It is not the same as swelling you can see from the outside. It is a signal change inside the bone that often matches an active injury.

Retropulsion

Retropulsion means part of the back wall of the vertebral body has moved backward toward the spinal canal. Reports may say trace, mild, moderate, or severe retropulsion.

Trace or mild retropulsion may not cause major narrowing, but it is still important because the spinal canal contains the spinal cord in the thoracic spine and nerve roots lower down. More significant retropulsion can raise concern for nerve or spinal cord pressure, especially if symptoms include weakness, numbness, trouble walking, or bowel or bladder changes.

Which vertebra is fractured?

Patients often want a simple answer: is it T12, L1, T7, or another level? Usually the report can identify this, but level numbering can sometimes be tricky, especially near the thoracic-lumbar junction where T12 meets L1. If there are unusual anatomy variants or limited images, different readers may describe the level differently.

When exact level matters for procedures or surgery, radiologists and spine clinicians may compare the MRI or CT with prior imaging, count from a known landmark, or use whole-spine images to confirm the numbering.

Does a compression fracture explain current pain?

A recent compression fracture often causes focal back pain near the injured level. Pain may be worse with standing, walking, bending, coughing, or getting in and out of bed. MRI marrow edema and tenderness over the same area can make the fracture more likely to be the pain source.

However, many spine studies also show arthritis, disc degeneration, facet joint changes, or old fractures. These can also contribute to pain. Imaging is one part of the puzzle, not the whole answer.

Is MRI needed after CT?

MRI is not always needed after CT. CT may be enough when the fracture is clearly explained, neurologic symptoms are absent, and the treatment plan would not change.

MRI may be considered when:

The age of the fracture is uncertain and it matters for treatment.
There are multiple compression deformities and doctors need to know which one is active.
There is concern about spinal canal narrowing, nerve pressure, or spinal cord involvement.
Pain is severe, worsening, or not matching the CT findings.
The fracture looks unusual, raising concern for infection, tumor, or another non-osteoporotic cause.

What happens if compression fractures are not managed?

Not every compression fracture requires a procedure, but it should be taken seriously. If not properly evaluated and managed, possible concerns include ongoing pain, further collapse of the vertebra, increasing forward curvature of the spine, reduced mobility, muscle weakness from inactivity, and higher fall risk.

Another important risk is missing the underlying cause. In many adults, especially those with known or suspected osteoporosis, a vertebral compression fracture can be a warning sign that bones are fragile. Bone health evaluation may include reviewing medications, vitamin D and calcium intake, fall risks, and whether a bone density test such as a DEXA scan is appropriate.

Less commonly, a fracture may be related to cancer, infection, or another medical condition. Imaging features, medical history, lab tests, and follow-up help clinicians decide whether more evaluation is needed.

Does a compression fracture mean surgery is needed?

Most vertebral compression fractures are treated without open surgery. General treatment approaches may include pain control, temporary activity changes, bracing in selected cases, physical therapy when appropriate, and osteoporosis treatment or prevention.

Some patients may be evaluated for procedures such as vertebroplasty or kyphoplasty, which are designed to stabilize certain painful compression fractures. These are not right for everyone, and decisions depend on fracture age, pain severity, imaging findings, overall health, and response to conservative care.

Open surgery is more often considered when there is spinal instability, progressive deformity, significant nerve or spinal cord compression, or neurologic deficits. A report showing mild height loss or trace retropulsion by itself does not automatically mean surgery is needed.

When to talk to your doctor

Talk with your doctor or spine specialist about which vertebra is fractured, whether it looks recent or old, whether MRI is needed, and whether osteoporosis evaluation is appropriate.

Seek urgent medical care for new leg weakness, numbness in the groin or saddle area, trouble walking, fever, rapidly worsening pain, or loss of bowel or bladder control. These symptoms can signal pressure on nerves or the spinal cord and should not wait for routine follow-up.

Vertebral Compression Fractures on CT vs MRI