vertebral fracture; spine fracture

Etiology

• lumbar & thoracic spine fractures are generally a result of trauma
  • motor vehicle accidents (1/3)
  • violence (1/4)
  • accidental falls
  • recreational sports
• osteoporosis
• malignant neoplasms
  • bone metastases
  • osteosarcoma
  • Kaposi sarcoma

Epidemiology

• 1/2 of vertebral fractures occur in the thoracic, lumbar & sacral regions; the other 1/2 in the cervical region
• 80% male; 55% < 30 years of age

Pathology

• thoracic spine is more susceptible than lumbar spine
  • spinal canal & vertebral bodies are proportionately smaller
  • vascular supply is less robust
    • few collateral vessels
    • small anterior spinal arteries
    • small radicular arteries

Clinical manifestations

• often triggered by minimal or ordinary activities
• pain worsens with postural movement (standing up, bending, lifting)
• pain is typically midline with tenderness on palpation or percussion of the affected spinous process
• pain generally resolves within 3 to 12 months
• physical examination findings may be normal
  • midline spinal tenderness at the fracture level
  • kyphosis
  • height loss > 2 cm from prior measurement

Radiology

• vertebral fracture assessment as part of bone mineral density DEXA study is useful for screening
• plain radiograph
  • helpful in screening for fractures
  • hairline fractures or nondisplaced fractures may be difficult to detect
• computed tomography
  • very sensitive
  • can identify even subtle fractures
• magnetic resonance imaging
  • modality of choice to detect spinal cord injury
  • sensitive for detecting lesions of both neural tissue & bone

Complications

• neurologic deficits
• pneumonia, pulmonary embolism & sepsis are the major causes of mortality

Management

• first aid
  • spinal immobilization for patients with major trauma & patients whose mechanism of injury is not clear
  • cervical spine immobilization device
  • logroll technique when transferring the patient onto a long spine board or rescue board
• once in the hospital
  • remove the patient from the board as soon as practical
    • some patients develop decubitus ulcers after 1 hour
• supportive care
  • ABC & immobilization
  • maintain hemodynamic stability
• high dose glucocorticoids may be of benefit
  • administer within 8 hours of injury
  • methylprednisolone 30 mg/kg bolus, then 5.4 mg/kg/hr after 1 hour for 23 hours
  • conflicting reports, risk of infection
• orthopedic surgery &/or neurosurgery consult
  • goals of surgery
    • decompress the spinal cord canal
    • stabilize the disrupted vertebral column
• long-term:
  • treat non-traumatic vertebral fractures for osteoporosis (regardless of T-score)

More general terms

• bone fracture

More specific terms

• cervical spine fracture
• sacral fracture
• vertebral compression fracture