Thoracic and lumbar compression fractures
Background
- Also known as a "wedge fracture"
- Only unstable if posterior ligament complex ruptures (requires a rotational force)
- Unlikely to cause cord damage
Clinical Features
- Mechanism: axial loading and flexion
Differential Diagnosis
Thoracic Trauma
- Airway/Pulmonary
- Cardiac/Vascular
- Cardiac injury
- Blunt cardiac injury
- Penetrating cardiac injury
- Cardiac tamponade
- Traumatic aortic transection
- Cardiac injury
- Musculoskeletal
- Other
Lower Back Pain
- Spine related
- Acute ligamentous injury
- Acute muscle strain
- Disk herniation (Sciatica)
- Degenerative joint disease
- Spondylolithesis
- Epidural compression syndromes
- Thoracic and lumbar fractures and dislocations
- Cancer metastasis
- Spinal stenosis
- Transverse myelitis
- Vertebral osteomyelitis
- Ankylosing spondylitis
- Spondylolisthesis
- Discitis
- Renal disease
- Intra-abdominal
- Abdominal aortic aneurysm
- Ulcer perforation
- Retrocecal appendicitis
- Large bowel obstruction
- Pancreatitis
- Pelvic disease
- PID
- Other
Evaluation
Compression fracture of the fourth lumbar vertebra post falling from a height.
X-ray of the lumbar spine with a compression fracture of the third lumbar vertebra.
Compression fracture of T12.
Diagnosis
- Suspect instability and obtain CT if:
- Severe compression (>50% loss of vertebral height)
- Kyphosis >30deg
- Rotational component to injury
- Compression fracture at multiple sites
- Posterior cortex abnormality
Management
- Nonoperative:orthosis, calcitonin, biphophanates.
- kyphoplasty
- vertebroplasty
- surgical decompression and stabilization
Disposition
Home if fracture stable and pain control optimal.
See Also
External Links
References
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