An unstable fracture can be the problem. Pressure through the spine can cause a damaged or fractured bone to collapse even more. Sometimes a standard X-ray will show the need for surgery to stabilize the spine after fracture. Doctors look for loss of vertebral body height and the amount of forward curve of the spine. This type of spinal curve is called kyphosis.

In other cases a second X-ray in the sitting or standing position is needed. It isn't until the patient puts weight or force through the spine that the damage is seen. Vertebral collapse of more than 50 percent with a greater than 20-degree kyphosis are usually signs that surgery may be needed.