Vertebral fractures

• Causes:

  • Trauma
  • Malignancy
  • Osteoporosis
• Vertebral compression fracture:

  • Multiple types but most common is a vertebral body compression fracture - most common cause of this type of fracture is osteoporosis
  • The weakened bone fracture at the front edge (anterior) causing it to compress the anterior spine, causing the shape to go from a rectangle to a wedge
  • Sometimes called anterior wedge compression fracture
• Symptoms:

  • Back pain over fractured vertebrae
  • Radiculopathy if compressing nerve roots
  • Decreased spine mobility and flexibility
  • Patients can lose height and develop kyphosis giving them a hunched over appearance - can develop acutely or chronically - can impact breathing, GI symptoms (reflux, difficulty swallowing) and affects ADLs
• If suspect fracture from history and examination need imaging to confirm:

  •Lateral x-ray

  •CT (Best modality to assess spinal fractures)

  •MRI (Good for assessing relationship between bony structures and soft tissues)
• Non-surgical management:

  •Analgesia

  •Short term bed rest

  •Back brace (promote fracture healing - stops patient bending forward- holds spine straight, takes pressure off fracture)

  •Physical therapy

  •Treat underlying condition e.g. osteoporosis, cancer etc
• Surgical management:

  • Vertebroplasty: Inject surgical cement into compressed vertebrae to harden and stabilise the fractured vertebrae
  • Kyphoplasty: Balloon inflated within vertebrae creating a cavity that bone cement injected into. This has added benefit of restoring height of vertebral body and reshapes it, cement then injected in to stabilise strengthen
  • Fusion with screws