The X-rays do not demonstrate a back fracture but a limbus vertebra. If you look carefully at the top of the L4 vertebra, you see a bone that looks like it split off of the top of L4 but it is a perfect triangle piece that would fit into the missing corner of the vertebra. You will also see that the L4 vertebra is wider than the L5 vertebra underneath it. These all have an explanation.
When you were younger, like all children, you had open growth plate rings at the top and the bottom of the vertebra. This is how your spine grew in height. One ring had a weak spot between the body of the vertebra and the ring. With a bend, a lift or a fall, you herniated a disc into one of the growth rings and split off a piece of the ring. Since this split piece was designed to grow, it did indeed continue to grow and that is what you see as the split off piece in the top corner of the vertebra.
The width or diameter of the vertebra normally gets larger with each lower vertebra being larger than the one above. If you look carefully, you will see that the diameter of L4 (the one with the limbus) is larger than L5 below it. The reason L4 is larger than L5 is that when you injured the L4 vertebra so many years ago, this injury stimulated more blood flow to L4 and it consequently grew larger than it’s lower neighbor, L5.
You state that you have significant lower back pain and right hip pain (I assume you mean the buttocks region and not the groin region). Most likely, you tore the annulus and possibly herniated a disc at the L4-5 level or the L3-4 level (both discs exhibit degenerative change on the X-ray).
If you have either one of these disorders, the typical treatment in my practice is an MRI, epidural injections and physical therapy or chiropractic treatment (see web site for descriptions of each). If there is pronounced muscle weakness, surgery should be considered.
Dr. Corenman
Donald Corenman, MD, DC is a highly-regarded spine surgeon, considered an expert in the area of neck and back pain. Trained as both a Medical Doctor and Doctor of Chiropractic, Dr. Corenman earned academic appointments as Clinical Assistant Professor and Assistant Professor of Orthopaedic Surgery at the University of Colorado Health Sciences Center, and his research on spine surgery and rehabilitation has resulted in the publication of multiple peer-reviewed articles and two books.