Although compression fractures can occur anywhere along the vertebral column, they are most common at the thoracolumbar junction involving the T8-T12, L1, and L4 vertebrae [1]. The incidence of this condition increases steadily with advancing age [2]. Lumbar compression fractures can be asymptomatic and may be detected incidentally in the elderly on lumbar X-rays or may present insidiously with a backache. The pain is typically in the midline, aching or stabbing in quality, non-radiating and severe enough to cause disability and interfere with activities of daily living. The pain is usually relieved by lying supine and is aggravated by standing or walking. The pain often persists even after the fracture has healed [3]. However young adults with lumbar compression fractures may be diagnosed with a severe back pain of sudden onset and neurologic deficits in the lower limbs following a vehicular accident. The incidence of associated radiculopathy increases with descending spinal levels [4]. In the elderly, multiple fractures over a period of time lead to decrease in height and stature with subsequent paraspinal muscle shortening, lumbar lordosis, and thoracic kyphosis. As a result, the individual has to actively contract the paraspinal muscles to maintain posture leading to fatigue and in severe cases, it can lead to impaired lung function, abdominal protuberance, compression of abdominal organs with early satiety and loss of weight [5].

Individuals with lumbar compression fractures secondary to malignancies like multiple myeloma or metastasis may present with fever of unknown origin, night sweats, anorexia, weight loss or a history of a previous breast or prostate malignancy.

• Fever of Unknown Origin

  Individuals with lumbar compression fractures secondary to malignancies like multiple myeloma or metastasis may present with fever of unknown origin, night sweats, anorexia, weight loss or a history of a previous breast or prostate malignancy. [symptoma.com]

• Nightmare

  Unfortunately, that dream holiday became a nightmare. [melioguide.com]

• Constipation

  Prescription pain medicine may cause constipation. Ask your healthcare provider how to prevent or treat constipation. Bisphosphonates and calcitonin may be recommended to help your bones get stronger. [drugs.com]

  This symptom can be caused by the shorter spine putting pressure on the stomach leading to stomach and digestive issues such as loss of appetite, constipation and weight loss. [apmhealth.com]

  These fractures can result in other complications, however, such as: Reduced spinal range-of-motion Lung disorders, such pneumonia or a collapsed lung Crowding of internal organs Constipation Bowel obstruction Progressive muscle weakness Deep venous thrombosis [paindoctor.com]

  […] is needed to avoid problems with kidneys and stomach Should not be taken for long periods if possible Opiates (medications related to morphine) These are very strong painkillers Available only on prescription Can cause drowsiness, confusion, falls, constipation [bsir.org]

  Crowding of internal organs Respiratory decrease-atelectasis, pneumonia Prolonged pain Low self-esteem Emotional and social problems Increased nursing home admissions Mortality TABLE 1 Complications from Compression Fractures of the Spine Constipation [aafp.org]

• Night Sweats

  Individuals with lumbar compression fractures secondary to malignancies like multiple myeloma or metastasis may present with fever of unknown origin, night sweats, anorexia, weight loss or a history of a previous breast or prostate malignancy. [symptoma.com]

• Back Pain

  METHODS: An 83-year-old male presented with low back pain two years after sustaining osteoporotic compression fracture at L3 due to a fall. [ncbi.nlm.nih.gov]

  It is by this mechanism that abdominal binders provide spinal support and hence relieve back pain. [oandplibrary.org]

  However young adults with lumbar compression fractures may be diagnosed with a severe back pain of sudden onset and neurologic deficits in the lower limbs following a vehicular accident. [symptoma.com]

  Here is what the vertebrae look like when affected by osteoporosis (porous bones): Plaintiff, of course, urged that since she never before had any back pain, or any treatment related to her back, all of her current complaints of pain and disability had [newyorkinjurycasesblog.com]

• Low Back Pain

  METHODS: An 83-year-old male presented with low back pain two years after sustaining osteoporotic compression fracture at L3 due to a fall. [ncbi.nlm.nih.gov]

  The majority of low back pain (LBP) is perceived to originate from the lumbar spine; however, another likely source of LBP that is mostly overlooked is the SIJ. [pubfacts.com]

  CONTINUE SCROLLING OR CLICK HERE FOR RELATED SLIDESHOW QUESTION Nearly everyone has low back pain at some time during their life. See Answer [medicinenet.com]

  Million, R., Nilsen Haavik, Jayson, M.I.V., and Baker, R.D., "Evaluation of low back pain and assessment of lumbar corsets with and without back supports," Ann. of the Rheum. Dis., 40:449 (1981). [oandplibrary.org]

• Spine Pain

  If fractures occur in the lower spine, wearing a brace is sometimes recommended to relieve pain and make walking less painful. How effective bracing is unclear. Sometimes bed rest is needed for a few days. [merckmanuals.com]

  Case presentation A 49 year-old Caucasian male presented with progressively worsening pain in the thoracic spine for 10 days and painful bilateral lower extremity edema. [casesjournal.biomedcentral.com]

• Loss of Lumbar Lordosis

  The change in shape of the vertebral body after a fracture may result in a visible focal increase in kyphosis or loss of lumbar lordosis.12,26,27 Multiple OVCFs can lead to a noticeable loss of height and a further accentuation in postural change.9,12 [ncbi.nlm.nih.gov]

• Urinary Retention

  Symptoms of a spine injury in the thoracic, lumbar and sacral regions can include: Neck or back pain, especially when moved Tenderness Numbness Tingling or a pricking sensation of the skin Paralysis Urinary or fecal incontinence Urinary retention To diagnose [chop.edu]

  Losing control ( incontinence ) of urine or stool or inability to urinate (urinary retention): If these symptoms are present, the fracture may be pushing on the spinal cord itself. [emedicinehealth.com]

  However, narcotics have significant side effects, including reduced gastrointestinal motility, urinary retention, reduced respiratory drive and cognitive deficits, with loss of balance, increase of falls and depression. 64 In addition, muscle relaxants [bmb.oxfordjournals.org]

Lumbar compression fracture should be suspected in postmenopausal women and the elderly who present with sudden onset severe lumbar pain. Many patients may remember a specific injury [6] although the condition may present without any prior history of trauma. Tenderness is typically elicited on palpating directly over the fracture site and there may also be kyphosis [7]. A thorough neurological examination is necessary but may not reveal any deficits in uncomplicated fractures.

Plain X-rays of the spine will confirm the diagnosis and reveal the classic wedge deformity corresponding to the site of maximum tenderness. A reduction in vertebral height by 20% or a decrease of at least 4 mm compared to the baseline height is an indication of a compression fracture [6]. Ideally, the entire spine should be imaged to exclude multiple fractures and occasionally serial imaging may be required to detect the fracture.

Techniques like computed tomography (CT), magnetic resonance imaging (MRI) help in diagnosis by excluding the other etiologies of back pain. They also confirm the integrity of the posterior vertebral wall [8]. In addition, a CT can detect a compression fracture (not visualized on plain radiographs), spinal canal narrowing and differentiate between a compression fracture and a burst fracture. An MRI is indicated in patients with neurologic deficits, or if a malignancy is suspected as the underlying cause of the lumbar compression fracture. Positron emission tomography (PET) can also be ordered to differentiate between compression fractures of benign versus malignant etiology.

Laboratory tests like erythrocyte sedimentation rate, complete blood count (CBC), prostate-specific antigen testing, serum protein electrophoresis to exclude multiple myeloma and urinalysis for Bence-Jones proteins should be routinely performed. Bone density scanning is recommended to measure the severity of osteoporosis and for further patient management [9].

Published on May 9, 2017 Deuk Spine Institute, Injury Treatment Group, Surgery Center of Viera. [youtube.com]

Two related procedures, vertebroplasty and kyphoplasty, are available for the patient with a lumbar wedge fracture who continues to experience pain despite aggressive conservative treatment. [4] Vertebroplasty Vertebroplasty has been available for many [emedicine.medscape.com]

This was an 81 year old woman with very little treatment and a pre-existing condition directly related to the injuries claimed at trial. [newyorkinjurycasesblog.com]

It can cause irreversible neurological complications if the appropriate treatment is not planned. [pubfacts.com]

Initial treatment was focused on providing adequate pain control. [ncbi.nlm.nih.gov]

Prognosis Gastric LP has a very poor prognosis due to the frequent occurrence of peritoneal dissemination, lymphatic invasion and extension toward neighboring organs. The 5-year survival rate is around 10-20% in Japan and Europe. [orpha.net]

Low-impact aerobic exercise like walking may be suggested by your physical therapist, but will depend on your progress and prognosis following injury or pain as well as what caused the compression fracture in the first place. [livestrong.com]

While the diagnosis can be suspected from history and physical examination, plain x-rays, as well as a CT scan or MRI, are often helpful in accurate diagnosis and prognosis. [uclahealth.org]

Treatment and prognosis Management options include: non-surgical observation/bracing medications: bisphosphonates for osteoporosis surgical vertebroplasty [radiopaedia.org]

Positron emission tomography (PET) can also be ordered to differentiate between compression fractures of benign versus malignant etiology. [symptoma.com]

Etiology LP is generally a sporadic disease but familial cases have been described. Etiology is unknown. [orpha.net]

[…] fracture of unspecified lumbar vertebra, initial encounter for open fracture see all Compression fracture ICDF-10 coding Compression Fractrue ICD-9 805.4 (Fracture of vertebral column without spinal cord injury (lumbar, closed) Compression Fractrue Etiology [eorif.com]

Often the patient will prefer to stand - reducing the axial load on the spine - instead of sitting. 1 If the patient is older than age 40, it is important to rule out pathologic weakening of the bone as an underlying etiology to the compression deformity [dynamicchiropractic.com]

Riggs, B.L., Melton L.J. 3rd, "The worldwide problem of osteoporosis: insights afforded by epidemiology," Bone, 1995, 17(5 Suppl): p. 505S-511S. Melton L.J. 3rd., "Epidemiology of spinal osteoporosis," Spine, 1997;22:2S-11S. [spine-health.com]

[…] of unspecified lumbar vertebra, initial encounter for open fracture see all Compression fracture ICDF-10 coding Compression Fractrue ICD-9 805.4 (Fracture of vertebral column without spinal cord injury (lumbar, closed) Compression Fractrue Etiology / Epidemiology [eorif.com]

Summary Epidemiology Gastric LP accounts for about 10% of all gastric cancers but the exact prevalence in the general population is unknown. [orpha.net]

Epidemiology of spinal osteoporosis. Spine. 1997;22(24 Suppl):2S–11S. ... 2. Melton LJ 3d, Kan SH, Frye MA, Wahner HW, O'Fallon WM, Riggs BL. Epidemiology of vertebral fractures in women. Am J Epidemiol. 1989;129:1000–11. 3. [aafp.org]

These worries are not unfounded, because there is a substantial risk of subsequent fractures of all types and further morbidity in persons who have had a vertebral compression fracture. 9 Pathophysiology and Risk Factors Vertebral compression fractures [aafp.org]

This is more serious and may require immediate treatment to prevent or relieve pressure on the spinal cord or nerves. [orthopedics.about.com]

Apart from preventing VCF or another VCF, treatment of osteoporosis also aims to prevent other fractures, particularly hip fractures. [bsir.org]

In several, small patient studies, preventive vertebroplasty for the adjacent vertebrae above and below combined with vertebroplasty for the acutely fractured vertebra was effective in the prevention and cascading of untreated adjacent fractures. [cureus.com]

Prevention Taking steps to prevent and treat osteoporosis is the most effective way to prevent compression or insufficiency fractures. Getting regular load-bearing exercise (such as walking) can help you avoid bone loss. [mountsinai.org]

Taking steps to prevent and treat osteoporosis is the most effective way to prevent compression or insufficiency fractures. Getting regular load-bearing exercise (such as walking) can help you avoid bone loss. [nlm.nih.gov]

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