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vertebral fracture; spine fracture
Etiology:
- lumbar & thoracic spine fractures are generally a result of trauma
- motor vehicle accidents (1/3)
- violence (1/4)
- accidental falls
- recreational sports
- osteoporosis
- malignant neoplasms
- bone metastases
- osteosarcoma
- Kaposi sarcoma
Epidemiology:
- 1/2 of vertebral fractures occur in the thoracic, lumbar & sacral regions; the other 1/2 in the cervical region
- 80% male; 55% < 30 years of age
Pathology:
- thoracic spine is more susceptible than lumbar spine
- spinal canal & vertebral bodies are proportionately smaller
- vascular supply is less robust
- few collateral vessels
- small anterior spinal arteries
- small radicular arteries
Radiology:
- vertebral fracture assessment as part of bone mineral density DEXA study is useful for screening [3]
- plain radiograph
- helpful in screening for fractures
- hairline fractures or nondisplaced fractures may be difficult to detect
- computed tomography
- very sensitive
- can identify even subtle fractures
- magnetic resonance imaging
- modality of choice to detect spinal cord injury
- sensitive for detecting lesions of both neural tissue & bone
Complications:
- neurologic deficits
- pneumonia, pulmonary embolism & sepsis are the major causes of mortality
Management:
- first aid
- spinal immobilization for patients with major trauma & patients whose mechanism of injury is not clear
- cervical spine immobilization device
- logroll technique when transferring the patient onto a long spine board or rescue board
- once in the hospital
- remove the patient from the board as soon as practical
- some patients develop decubitus ulcers after 1 hour
- supportive care
- ABC & immobilization
- maintain hemodynamic stability
- high dose glucocorticoids may be of benefit
- administer within 8 hours of injury
- methylprednisolone 30 mg/kg bolus, then 5.4 mg/kg/hr after 1 hour for 23 hours
- conflicting reports, risk of infection
- orthopedic surgery &/or neurosurgery consult
- goals of surgery
- decompress the spinal cord canal
- stabilize the disrupted vertebral column
- long-term: [3]
- treat non-traumatic vertebral fractures for osteoporosis (regardless of T-score)
Specific
cervical spine fracture
sacral fracture
vertebral compression fracture
General
bone fracture
References
- Reiter GT
eMedicine (Medscape): Vertebral Fracture
http://emedicine.medscape.com/article/248236-overview
- Ensrud KE, Schousboe JT.
Clinical practice. Vertebral fractures.
N Engl J Med. 2011 Apr 28;364(17):1634-42.
PMID: 21524214
- Geriatric Review Syllabus, 9th edition (GRS9)
Medinal-Walpole A, Pacala JT, Porter JF (eds)
American Geriatrics Society, 2016
- Geriatric Review Syllabus, 10th edition (GRS10)
Harper GM, Lyons WL, Potter JF (eds)
American Geriatrics Society, 2019
- Papaioannou A, Watts NB, Kendler DL et al
Diagnosis and management of vertebral fractures in elderly
adults.
Am J Med. 2002 Aug 15;113(3):220-8. Review.
PMID: 12208381