Spinal Compression Fracture

Question 1

What are common etiologies of vertebral compression fracture (VCF)?

Answer 1

• Trauma (often trivial)
• Osteoporosis
• Osteomalacia
• Metastases to the Bone
• Metabolic conditions (e.g., hyperparathyroidism)
• Paget disease

Question 2

What are the acute clinical features of vertebral compression fracture?

Answer 2

• Back pain
• Decreased spinal mobility
• Pain increasing with standing, walking, or lying on the back
• Referred pain to the abdomen or flank
• Spinal tenderness at the affected level

Question 3

What are the chronic clinical features of vertebral compression fracture?

Answer 3

• Painless presentation
• Progressive kyphosis
• Loss of height

Question 4

What are typical triggers for vertebral compression fractures?

Answer 4

Minimal trauma such as lifting, twisting, coughing, or falling from standing height, especially in patients with osteoporosis or low bone mineral density.

Question 5

What are common common risk factors of vertebral compression fractures in older adults?

Answer 5

• Age >65 years
• Decreased bone density from osteoporosis
• Postmenopausal status
• Minor trauma experienced after lifting, twisting, or coughing

Question 6

What are potential complications of vertebral compression fracture?

Answer 6

• Increased risk for future fractures
• Hyperkyphosis leading to protuberant abdomen
• Early satiety
• Weight loss
• Decreased respiratory capacity

Question 7

What are common physical examination findings in vertebral compression fracture?

Answer 7

• Pain localized to the midline
• Pain that persists at night
• Vertebral point tenderness
• Lack of neurologic deficits in most cases

Question 8

What imaging modalities are used to diagnose vertebral compression fracture?

Answer 8

Plain X-ray of the spine, with MRI or CT scan if the diagnosis is uncertain or malignancy is suspected.

Question 9

What additional screening studies should be performed in patients with vertebral compression fracture?

Answer 9

• Screening for hyperthyroidism
• Screening for Hyperparathyroidism
• Screening for vitamin D deficiency
• DEXA scan to evaluate bone density

Question 10

How does apophyseal joint arthritis (e.g., ankylosing spondylitis) differ from vertebral compression fracture?

Answer 10

Apophyseal joint arthritis presents with chronic, progressive pain worse at night and with prolonged rest, usually beginning before age 40 (the younger patient population).

Question 11

How does degenerative disc disease differ from vertebral compression fracture?

Answer 11

Degenerative disc disease presents with chronic pain that worsens with activity and improves with rest, often associated with acute lumbosacral radiculopathy due to disc herniation.

Question 12

How does ligamentous back sprain differ from vertebral compression fracture?

Answer 12

Ligamentous back sprain pain is usually relieved with rest and tenderness is seen in the paraspinal tissues rather than the midline.

Question 13

How does nerve root demyelination (e.g., Guillain-Barré syndrome) differ from vertebral compression fracture?

Answer 13

Pain due to inflammation may be present. However, nerve root demyelination presents with ascending paresthesia, weakness, absent deep tendon reflexes, and is not associated with focal vertebral tenderness.