Vertebral Fractures

Question 1

List 4 causes of vertebral fracture

Answer 1

Osteoporosis (most common)
Malignancy (bone mets)
Infection (TB: Pott disease)
Trauma

Question 2

How are vertebral fractures classified?

Answer 2

Stable: structural stability intact, no neurological deficits (fractures of anterior column)
Unstable: structural stability compromised, spine can move as 2 or more units (mid column + posterior)

Question 3

What is the most important feature of any spinal column injury?

Answer 3

Degree of fracture stability

Question 4

What is the most common type of vertebral fracture?

Answer 4

Vertebral compression fracture
Caused by pathological fractures or trauma

Question 5

Give 2 features of vertebral compression fractures

Answer 5

Usually stable
Often asymptomatic, but may cause acute back pain + point tenderness

Question 6

Give 2 long term findings of vertebral compression fractures

Answer 6

Progressive thoracic kyphotic deformity if multiple vertebrae are affected (stooped posture with a “dowager’s hump”)
Decreased height

Question 7

List 3 types of vertebral fracture

Answer 7

Vertebral compression fracture
Burst fracture: fracture of vertebra in multiple locations
Fracture-dislocation: fractured vertebrae + disrupted ligaments

Question 8

List 5 possible clinical features of vertebral fractures

Answer 8

Local pain on pressure, percussion, + compression
Palpable unevenness or disruption of vertebral process alignment
Paravertebral hematoma
Weakness or numbness/ tingling
Neurogenic shock

Question 9

List 4 ways in which an osteoporotic vertebral fracture may present

Answer 9

Asymptomatic: incidental finding on X-ray
Acute back pain
Breathing difficulties: changes in shape + length of vertebrae lead to compression of organs inc. lungs, heart + intestine
GI problems: due to compression of abdominal organs

Question 10

How do vertebral fractures lead to loss of height?

Answer 10

Compression of spinal vertebrae hence reduction in overall length of the spine + thus patient becomes shorter

Question 11

Describe examination in suspected vertebral fracture

Answer 11

Neuro exam: CN, UL, LL
Rectal exam: sphincter tone
Secondary survey in trauma

Question 12

The absence of which 5 criteria make risk of C-spine fracture low?

Answer 12

Focal neurological deficit
Posterior midline cervical spine tenderness
Altered consciousness
Intoxication
Painful distracting injury

Question 13

What imaging should be performed first line in suspected vertebral fracture?

Answer 13

AP + Lateral XR
May show wedging of vertebra due to compression of bone

Question 14

Which 2 imaging modalities may be used in vertebral fractures following XR?

Answer 14

CT: more detailed view of bone structure, therefore can visualise extent/ features of fracture more clearly
MRI: Differentiating osteoporotic fractures from those caused by another pathology e.g. a tumour

Question 15

Describe initial management of suspected vertebral fracture

Answer 15

Place patient on a long backboard ; move to stretcher once in hospital.
For possible injury of cervical spine: immobilisation with a rigid cervical collar

Question 16

Describe management of stable vertebral fractures

Answer 16

Analgesia
Physio
External bracing + orthotics to maintain spinal alignment, promote healing + control pain through immobilisation for ~ 8–12w

Question 17

What management is indicated in patients with unstable vertebral fractures
and/or neurological symptoms?

Answer 17

Spondylodesis
Fusion of 2 or more vertebral bodies via internal fixation using plates, rods, screws, or cages

Question 18

What management is indicated in patients with stable vertebral compression fractures
with progressive pain or kyphosis despite conservative treatment?

Answer 18

Vertebroplasty: injection of bone cement into fractured vertebra for immediate stabilisation

Kyphoplasty: re-expansion of the fracture through insertion of an inflatable balloon into the vertebral body + injection of bone cement

Question 19

Give 3 complications of spinal cord injury

Answer 19

Severe injury of spinal cord → Resp depression
Spinal contusion/ concussion to spinal shock
→ neurological deficits
Injuries of C-spine may result in a retropharyngeal hematoma → dysphagia

Question 20

3 Complications of vertebral fracture

Answer 20

Spinal cord injury
Vessel injury
Deformation of spine: kyphosis, scoliosis