eMedicine Specialties > Neurosurgery > Spine

Vertebral Fracture: Workup

Author: G Timothy Reiter, MD, Assistant Professor, Department of Neurosurgery, Penn State College of Medicine; Director, Department of Spinal Neurosurgery and Neurotrauma, Penn State Hershey Medical Center
Contributor Information and Disclosures

Updated: Apr 13, 2009

Workup

Laboratory Studies

  • Laboratory studies are not useful in the diagnostic workup of patients with vertebral fractures, although they are important ancillary studies for evaluating possible comorbid conditions.
  • Patients with vertebral or pelvic fractures resulting from a major trauma require serial hemoglobin determinations as an indicator of hemodynamic stability.
  • Other laboratory studies aid the evaluation of associated organ damage.
    • A urinalysis or urine dip for blood can help rule out associated kidney injury.
    • An elevated amylase or lipase level may suggest pancreatic injury.
    • Elevated cardiac markers in the setting of chest trauma may indicate a cardiac contusion.
    • Elevated urine myoglobin or serum creatine kinase level in the context of a crush injury may indicate evolving rhabdomyolysis.
    • A pregnancy test should be obtained in females of childbearing age.
  • In patients with metastatic disease to the bone and resultant pathologic fractures, a serum calcium determination is necessary. These patients may have hypercalcemia that requires medical attention.
  • Routine laboratory analysis is part of the preoperative workup. The evaluation should include a complete blood cell count, serum chemistries, coagulation profile, and urinalysis. Results of these studies have a bearing on total patient care rather than specific issues related to the fracture.

Imaging Studies

  • Upon initial presentation to the emergency department, plain radiographs should be obtained if a vertebral fracture is suggested based on the results of the clinical examination. Plain radiographs are helpful in screening for fractures, but hairline fractures or nondisplaced fractures may be difficult to detect.
  • CT scan imaging can readily detect bony fractures and help with the assessment of the extent of fractures. CT scans are very sensitive and can identify even subtle fractures. A CT myelogram can be used to determine the degree of impingement of the bony fragments on the thecal scan when MRI imaging is not available or is contraindicated.
  • MRI is usually the study of choice to detect the extent of damage to the spinal cord. MRI is the most sensitive tool for detecting lesions of both neural tissue and bone.

Other Tests

  • Bone densitometry can be performed in an attempt to predict the risk of fracture from osteoporosis. Results from an imaging study such as plain radiography or spiral CT scan can be compared to a known standard. Patients with significant loss of bone density can be given treatment to enhance bone deposition.

Histologic Findings

A tissue sample from a presumed pathologic fracture may be used to evaluate the tissue type of the primary cancer.

Staging

For patients with metastatic disease, staging of the primary cancer is important and is used to guide treatment.

More on Vertebral Fracture

Overview: Vertebral Fracture
Workup: Vertebral Fracture
Treatment: Vertebral Fracture
Follow-up: Vertebral Fracture
Multimedia: Vertebral Fracture
References
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Further Reading

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Keywords

Chance fracture, seatbelt syndrome, pathologic fracture, wedge fracture, compression fracture, spinal cord injury, spinal cord injuries, vertebra fracture, broken back, thoracic spinal cord injury, thoracolumbar spinal fracture, burst fracture, seat belt fracture, seatbelt fracture, flexion-rotation injury, flexion-distraction injury, shear injury, flexion-rotation fracture, flexion-distraction fracture, shear fracture, osteoporosis, osteoporosis fracture, bone disease, brittle bone, back pain, vertebral body fracture, Pott disease, Pott's disease, tuberculous spondylitis, tuberculosis spondylitis, osteomyelitis, sagittal slice fracture, posterior lumbar interspinous fusion, PLIF, Z-plate anterior thoracolumbar plating system, anterior arthrodesis

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Contributor Information and Disclosures

Author

G Timothy Reiter, MD, Assistant Professor, Department of Neurosurgery, Penn State College of Medicine; Director, Department of Spinal Neurosurgery and Neurotrauma, Penn State Hershey Medical Center
G Timothy Reiter, MD is a member of the following medical societies: American Association of Neurological Surgeons
Disclosure: Synthes Spine Consulting fee Consulting; Integra Grant/research funds None

Medical Editor

Michael G Nosko, MD, PhD, Chief, Division of Neurosurgery, Director of Neurovascular Surgery, Medical Director of Neuroscience Unit, Associate Professor, Department of Surgery, University of Medicine and Dentistry at New Jersey
Michael G Nosko, MD, PhD is a member of the following medical societies: Academy of Medicine of New Jersey, Alpha Omega Alpha, American Association of Neurological Surgeons, American College of Surgeons, American Heart Association, American Medical Association, New York Academy of Sciences, and Society of Critical Care Medicine
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: Nothing to disclose.

Managing Editor

Allen R Wyler, MD, Former Medical Director, Northstar Neuroscience, Inc
Allen R Wyler, MD is a member of the following medical societies: American Academy of Neurological and Orthopaedic Surgeons, American Association of Neurological Surgeons, and Society of Neurological Surgeons
Disclosure: Nothing to disclose.

CME Editor

Paolo Zamboni, MD, Professor of Surgery, Chief of Day Surgery Unit, Chair of Vascular Diseases Center, University of Ferrara, Italy
Paolo Zamboni, MD is a member of the following medical societies: American Venous Forum and New York Academy of Sciences
Disclosure: Nothing to disclose.

Chief Editor

Allen R Wyler, MD, Former Medical Director, Northstar Neuroscience, Inc
Allen R Wyler, MD is a member of the following medical societies: American Academy of Neurological and Orthopaedic Surgeons, American Association of Neurological Surgeons, and Society of Neurological Surgeons
Disclosure: Nothing to disclose.

 
 
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