OSTEOPOROTIC COMPRESSION FRACTURE: SALIENT POINTS

*most common spine fracture in the emergency dept.
* female > male
* sudden onset pain in midback after a simple maneuvre such as coughing or lifting of weight
* 20% have asymptomatic fracture
* neurological deficit is rare after simple compression fracture
* 3 patterns of fracture ---> wedge, codfish and vertebra plana type
* CT should be taken if middle column involvement is suspected
* suspect burst fracture if interpedicular distance is increased or posterior vertebral height is decreased

* Admission if:
severe pain
ileus
urinarty retention
neurological comlications

* Bracing is offered to patient and he is then mobilised
* BMD is must for all osteoporotic fractures and approprite treatment is then instituted
* brace for 6-12 weeks
* after that----> extension exercise programme and low impact aerobics
* If significant pain after a few weeks---->Vertebroplasty is a good option
* Kyphotic deformity aftre repeated compression fractures---->ribs impinge on the pelvis,poor posture, protuberant abdomen, respiratory compromise

How to differentiate between osteoporotic fracture and tumour:

Patient with tumour has:
* severe pain and any movement is painful
* neurological signs are present
* plain x-ray shows: cortical destruction loss of pedicle compression fracture above T-7 or below L-2
* past H/O malignancy*MRI shows: obliteration of marrow cavity, with no fatty marrow left cortical margins are gray and mottled soft tissue mass outside the vertebral body causing cord effacement skip lesions gadolinium not a reliable choice to differentiate between benighn and malignant
* bone scan is useful to differentiate between benign and malignanat tumours* CT-guided biopsy is necessary if doubt persists

D/D OF SEVERE ACUTE BACK PAIN IN DIFFERENT AGE GROUPS

Infancy and Adolescence:
* Vertebral Osteomyelitis
* Osteoid Osteoma
* Spondylolysis
* Scheurmann disease

Young and Middle age adults:
* Premature disc degeneration
* spondyloarthropathy
* Trauma

Old Adults:
* Disc degeneration
* exclude other causews

Old Patients:
* Metastasis
* Infection
* Osteoporotic compression fracture