Vertebral Compression Fracture (VCF)

Diagnosis Definition

• VCFs account for nearly half of all thoracolumbar fractures and are typically associated with osteoporosis in the elderly and with high-speed trauma
• They generally involve only the anterior column (anterior longitudinal ligament, anterior two-thirds of the vertebral body, and annulus fibrosus) and are therefore stable
• Vertebroplasty (injecting a form of cement polymer into the fractured vertebral body) and kyphoplasty (similar to vertebroplasty, except a balloon is used to expand the volume of the fractured segment prior to introducing the cement polymer) are used in patients with persistent pain despite aggressive conservative treatment

Imaging Findings

• VCFs are best demonstrated on lateral or sagittal projections as caudal displacement of the anterosuperior endplate
• Fracture is indicated when there is a discrepancy of greater than 2 mm between the anterior and posterior height of the vertebral body, except at T12-L1 where this finding may be normal
• Anterior vertebral body height loss is typically less than 50%
• Acute fractures (more recent than three months) result in hyperintensity on T2 or short tau inversion recovery (STIR) sequences representing bone marrow edema

KEY IMAGES

Pearls

• 50% or greater loss of anterior vertebral body height, either at the time of injury or on follow-up examinations, may indicate posterior column disruption and mechanical instability
• MRI is the most sensitive modality (especially STIR sequences) for evaluating signal changes in the bone marrow, ligamentous integrity, and soft tissue damage (edema or hemorrhage)
• Expansion of the fractured vertebral body, an epidural and/or paraspinal soft tissue mass, or discrete lesions within the bone (especially if destructive) suggest malignancy
• Contraindications to vertebro/kyphoplasty include current neurologic compromise, burst fractures (fractures of the posterior vertebral body wall), spine infections, current sepsis, or underlying bleeding diatheses

References

1. Angtuaco EJ, Binet EF. Radiology of thoracic and lumbar fractures. Clin Orthop Relat Res 1984; 189:43-57
2. Campbell SE, Phillips CD, Dubovsky E, et al. The value of CT in determining potential instability of simple wedge compression fractures of the lumbar spine. AJNR Am J Neuroradiol 1995; 16(7):1385-1392
3. Shah LM, Jennings JW, Kirsch CFE, et al. Expert Panels on Neurological Imaging, Interventional Radiology, and Musculoskeletal Imaging: ACR Appropriateness Criteria® Management of Vertebral Compression Fractures. J Am Coll Radiol 2018; 15(11S):S347-S364