Spinal Compression Fractures
- Atraumatic Compression Frx:
- diff Dx:
- pagets disease
- multiple myeloma;
- Back pain and vertebral crush frxs: an unemphasized mode of presentation for primary hyperparathyroidism.
- sed rate:
- serum ca:
- serum phos:
- alkaline phosphatase:
- Traumatic Compression Frx:
- determine whether the frx is stable or unstable
- these frx are normally stable (assumming the dx is correct) & rarely involve neurologic comprimise;
- diff dx:
- burst frx of spine
- Chance frx
- be suspicious of "compression" fractures in young patients involved in MVA;
- a good quality AP radiograph may help rule out compression frx (absence of posterior element frx);
- Denis Classification:
- 4 types of compression frx according to Denis classification;
- Type A - involvement of both end plates;
- Type B - involvement of superior end plate;
- Type C - inferior end plate;
- Type D - buckling of anterior cortex w/ both end plates intact;
- compression frx result from anterior or lateral flexion causing failure of the anterior column;
- middle column remains intact & may act as hinge;
- in some cases there may be disruption of posterior column in tension, as upper segments hinge forward on middle column;
- Radiographic Studies:
- radiographs: (see radiographs for burst frx)
- anterior ht of vertebra body is diminished, while posterior ht remains nl;
- there is no anterior or posterior translation of the vertebral bodies;
- amount of anterior compression should be no more than 40 % (relative to posterior vertebral body height (otherwise a burst frx may be present);
- CT Scan:
- allows good visualization of the posterior elements, which is necessary inorder to rule out the possibility of Chance fracture;
- visualizes spinal canal, degree of neural compromise, and delineates element involvement, particularly in a burst fracture;
- disadvantage of axial CT is its inability to detect subtle horizontally oriented fractures of the vertebral bodies, pedicles, or lamina;
- minimal vertebral body compression fractures may be missed;
- many of these problems are overcome by frontal & sagittal reformation.
- Non Operative Treatment:
- non operative treatment remains the standard for compression fx;
- most pts can be treated symptomatically w/ short period of bed rest until pain is diminished;
- in some cases an NG tube is required for severe ileus;
- if bowel sounds and flatus are not present then patient should be made NPO, and should receive IV Fluid;
- early ambulation is encouranged in a hyperextion orthosis;
- avoidance of compression overloads for a period of 12 weeks;
- depending on degree of compression, pt may be treated effectively by hyperextension exercises & avoidance of compression overloads for period of approximately 12 weeks.
- early ambulation is encouraged in a hyperextension orthosis.
- Treatment of Unstable Frx:
- definition of unstable frx:
- loss of 50% of vertebral body height;
- angulation of thoracolumbar junction > 20 deg;
- multiple adjacent compression frx;
- failure of 2/3 of columns of spine;
- spinal segment will fail with weight bearing;
- even w/ spinal instability - may have good response w/ a hyperextsion cast;
- note: a brace should not be considered a substitute for a well molded hyperextension cast;
- ref: Quality of Life Following Vertebroplasty.
- post injury care:
- watch for increasing kyphotic deformity or if pt's pain has not resolved, elective stabilization and arthrodesis should be considered
Anterolateral compression fracture of the thoracolumbar spine. A seat belt injury.
Assessment of the risk of vertebral fracture in menopausal women.
Vertebral fractures without neurological deficit. A long-term follow-up study.
Late outcome of nonoperative management of thoracolumbar vertebral wedge fractures.
Prospective Measurement of Function and Pain in Patients with Non-Neoplastic Compression Fractures Treated with Vertebroplasty.
Original Text by Clifford R. Wheeless, III, MD.
Last updated by Data Trace Staff on Wednesday, April 11, 2012 4:50 pm