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

• See Spine 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

• Cervical: A/P, Lateral, Odontoid:
• Thoracic and lumbar spine. A/P and Lateral views.
• CT cervical spine:
• MRI:

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

• See Cervical Spine Trauma 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

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