Spinal Compression Fracture Flashcards
What are common etiologies of vertebral compression fracture (VCF)?
- Trauma (often trivial)
- Osteoporosis
- Osteomalacia
- Metastases to the Bone
- Metabolic conditions (e.g., hyperparathyroidism)
- Paget disease
What are the acute clinical features of vertebral compression fracture?
- 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
What are the chronic clinical features of vertebral compression fracture?
- Painless presentation
- Progressive kyphosis
- Loss of height
What are typical triggers for vertebral compression fractures?
Minimal trauma such as lifting, twisting, coughing, or falling from standing height, especially in patients with osteoporosis or low bone mineral density.
What are common common risk factors of vertebral compression fractures in older adults?
- Age >65 years
- Decreased bone density from osteoporosis
- Postmenopausal status
- Minor trauma experienced after lifting, twisting, or coughing
What are potential complications of vertebral compression fracture?
- Increased risk for future fractures
- Hyperkyphosis leading to protuberant abdomen
- Early satiety
- Weight loss
- Decreased respiratory capacity
What are common physical examination findings in vertebral compression fracture?
- Pain localized to the midline
- Pain that persists at night
- Vertebral point tenderness
- Lack of neurologic deficits in most cases
What imaging modalities are used to diagnose vertebral compression fracture?
Plain X-ray of the spine, with MRI or CT scan if the diagnosis is uncertain or malignancy is suspected.
What additional screening studies should be performed in patients with vertebral compression fracture?
- Screening for hyperthyroidism
- Screening for Hyperparathyroidism
- Screening for vitamin D deficiency
- DEXA scan to evaluate bone density
How does apophyseal joint arthritis (e.g., ankylosing spondylitis) differ from vertebral compression fracture?
Apophyseal joint arthritis presents with chronic, progressive pain worse at night and with prolonged rest, usually beginning before age 40 (the younger patient population).
How does degenerative disc disease differ from vertebral compression fracture?
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.
How does ligamentous back sprain differ from vertebral compression fracture?
Ligamentous back sprain pain is usually relieved with rest and tenderness is seen in the paraspinal tissues rather than the midline.
How does nerve root demyelination (e.g., Guillain-Barré syndrome) differ from vertebral compression fracture?
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.
