Vertebral Compression Fracture
synonyms:Vertebral Compression Fracture, thoracic compression fracture cervical compression fracture
Compression Fractrue ICD-9
- 805.4 (Fracture of vertebral column without spinal cord injury (lumbar, closed)
Compression Fractrue Etiology / Epidemiology / Natural History
- Compressive failur fo the anterior vertbral body with preservation of the posterior body, PLL and posterior column. Minimal kyphosis, no canal compromise
Compression Fractrue Anatomy
Compression Fractrue Clinical Evaluation
- Palpate entire spine for tenderness / step off.
- Complete neuro exam: motor strength, pin-prick sensation, reflexes, cranial nerves, rectal examination (perineal pin-prick sensation, sphincter tone, volitional spincter control)
- Absence of the bulbocaverosus reflex indicates spinal shock. Level of spinal injury can not be determined until bulbocaverosus reflex has returned.
- See ASIA form.
Compression Fractrue Xray / Diagnositc Tests
Compression Fractrue Classification / Treatment
- Less than 50% height loss: thoracolumbrosacral (TLSO) orthosis or Jewett extension brace for 6-12 weeks
- Cervical: anterior vertibral compression with preservation of the posterior body, PLL and posterior column. Generally stable
-Treatment = orthosis x 6-12 weeks.
- Thoracolumbar TLICSS <3: short period bedrest followed by mobilization in TLSO ro Risser-like body cast with spine in hyperextension for 10-12 weeks.
- Thoracolumbar TLICSS <5: surgery
- Percutaneous Vertebroplasty is associated with immediate, significant and lasting reduction in back pain, and overall improvement in physical and mental health. (Muijs JBJS 2009;91B:379)
- 16% of osteoporotic women with vertebral fractures with have new vertebral fractures within 2 years. Teriparatide (20-40 ug SQ QD) and Raloxifene (60-120mg PO QD) decrease new vertebral fracture risks by @70% and @50% respectively. (Bouxsein ML, JBJS 2009;91A:1329). Also should be taking Calcium 500-1000mg QD and Vitamin D 400-1200 IU QD.
Compression Fractrue Associated Injuries / Differential Diagnosis
Compression Fractrue Complications
Compression Fractrue Follow-up Care
- PT started when tolerated.
- Patients with minimal compression and no neuro involvement may return to sports when they are painfree and full strength and flexibility.
Compression Fractrue Review References