Spinal Compression Fractures

- Atraumatic Compression Frx:
      - diff Dx:
              - osteoporosis
              - osteomalacia
              - pagets disease
              - multiple myeloma;
              - hyperparathyroidism
                    - reference:
                          - Back pain and vertebral crush frxs: an unemphasized mode of presentation for primary hyperparathyroidism.                           
      - labs:
              - 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;
    - Mechanism:
           - 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;
    - kyphoplasty:
           - 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.

Guideline on the Treatment of Symptomatic Osteoporotic Spinal Compression Fractures

Original Text by Clifford R. Wheeless, III, MD.

Last updated by Data Trace Staff on Wednesday, April 11, 2012 4:50 pm