Thoracic and lumbar compression fractures: Difference between revisions
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==== | ==Background== | ||
*Also known as a "wedge fracture" | |||
*Only unstable if posterior ligament complex ruptures (requires a rotational force) | *Only unstable if posterior ligament complex ruptures (requires a rotational force) | ||
*Unlikely to cause cord damage | |||
{{Vertebral fractures and dislocations types}} | |||
==Clinical Features== | |||
*Mechanism: axial loading and flexion | *Mechanism: axial loading and flexion | ||
==Differential Diagnosis== | |||
{{Thoracic trauma DDX}} | |||
{{Lower back pain DDX}} | |||
==Evaluation== | |||
[[File:L4 compressionFracture2008.jpg|thumb|Compression fracture of the fourth lumbar vertebra post falling from a height.]] | |||
[[File:Compressionfracture.jpg|thumb|X-ray of the lumbar spine with a compression fracture of the third lumbar vertebra.]] | |||
[[File:T12compressionfracMark.png|thumb|Compression fracture of T12.]] | |||
===Workup=== | |||
===Diagnosis=== | |||
*Suspect instability and obtain CT if: | *Suspect instability and obtain CT if: | ||
**Severe compression (>50% loss of vertebral height) | **Severe compression (>50% loss of vertebral height) | ||
Line 9: | Line 25: | ||
**Compression fracture at multiple sites | **Compression fracture at multiple sites | ||
**Posterior cortex abnormality | **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== | |||
*[[Anterior cervical wedge fracture]] | |||
==External Links== | |||
==References== | |||
<references/> | |||
Latest revision as of 15:45, 27 January 2021
Background
- Also known as a "wedge fracture"
- Only unstable if posterior ligament complex ruptures (requires a rotational force)
- Unlikely to cause cord damage
Vertebral fractures and dislocations types
- Cervical fractures and dislocations
- Thoracic and lumbar fractures and dislocations
Clinical Features
- Mechanism: axial loading and flexion
Differential Diagnosis
Thoracic Trauma
- Airway/Pulmonary
- Cardiac/Vascular
- 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
- Spinal Infarct
- Renal disease
- Intra-abdominal
- Abdominal aortic aneurysm
- Ulcer perforation
- Retrocecal appendicitis
- Large bowel obstruction
- Pancreatitis
- Pelvic disease
- Other
Evaluation
Workup
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.