Assessment & Diagnosis
Assessment & Diagnosis
Because many patients and their families regard back pain as an unavoidable consequence of aging, approximately two-thirds of vertebral compression fractures (VCFs) go undiagnosed. Additionally, some VCFs can take days to weeks to develop. Given these two factors, compression fractures should be suspected in patients older than 50 years with acute onset of sudden low back pain. Most patients will remember a specific injury as the cause, but some fractures may occur without any history of increased force on the spine.
Assessment: Contributing Risk Factors
VCFs are recognized as a hallmark of osteoporosis,[1] and many of the risk factors are the same.[2] Other risk factors include trauma or use of steriods and anticonvulsive medications. Additionally, a history of a VCF and other fractures, such as the wrist, are strong predictors of a subsequent VCF.[3][4]
Diagnosis: Physical Examination
A physical examination will reveal tenderness directly over the area of acute fracture, made worse by standing or walking. VCF pain is usually localized to the fracture area and is nonradicular. Palpitation often elicits pain.[5] An increased kyphosis may also be noted.[6] In cases of uncomplicated compression fractures, straight leg raise will be negative and neurologic examination will be normal.[7]
Diagnosis: Radiology
The diagnosis can be confirmed if plain radiography films and/or STIR sequence MRI show the classic wedge deformity correlating with the area of tenderness found on physical examination.[8] MRI is also an excellent tool to exclude other causes of back pain, as well as to identify the best vertebral bodies to treat.
VCF on Plain Film
VCF on MRI
A bone scan is useful for determining bone density. CT scans can be helpful for identifying a suspected fracture that is not well visualized on plain films.
VCF Bone Scan
CT Scan of Healthy Vertebra
Downloads
VCF Evaluation Algorithm. (50 KB, PDF)
Did you know?
Osteoporosis is responsible for more than 1.5 million fractures annually, the majority of which are vertebral fractures.[9]
