From the Guidelines
The major difference between a vertebral body compression fracture and a burst fracture is the direction and pattern of the fracture, with compression fractures involving vertical compression of the anterior portion of the vertebra and burst fractures involving compression in all directions, causing the vertebra to shatter and potentially compromise the spinal cord or nerve roots. This distinction is crucial in determining the appropriate treatment approach, as compression fractures may be managed conservatively with pain control, bracing, and possibly vertebroplasty or kyphoplasty 1, whereas burst fractures frequently require surgical intervention with spinal fusion and instrumentation to stabilize the spine and decompress neural elements if neurological compromise is present. The Spinal Instability Neoplastic Score (SINS) is a useful tool in evaluating spinal stability in patients with metastatic spinal disease, and can help guide management decisions 1. Key differences between compression and burst fractures include:
- Direction and pattern of fracture: compression fractures involve vertical compression of the anterior portion of the vertebra, while burst fractures involve compression in all directions
- Stability: burst fractures are more severe and unstable than compression fractures
- Treatment approach: compression fractures may be managed conservatively, while burst fractures frequently require surgical intervention
- Etiology: compression fractures often occur in patients with osteoporosis from minimal trauma or even normal activities, while burst fractures typically result from high-energy trauma like falls from height or motor vehicle accidents. According to the most recent study 1, the treatment of spinal metastases depends on symptoms, imaging findings, and overall prognosis, and may involve surgical intervention, radiation therapy, or percutaneous cement augmentation.
From the Research
Vertebral Body Compression Fracture vs Burst Fracture
The provided studies do not directly compare vertebral body compression fractures and burst fractures. However, we can discuss the characteristics of vertebral body compression fractures:
- Vertebral compression fractures are the most common complication of osteoporosis, affecting approximately 700,000 Americans annually 2, 3.
- They typically present with abrupt-onset low back pain with or without a history of trauma, although more than two-thirds are detected incidentally 2, 3.
- Diagnosis is confirmed using plain radiographs, while computed tomography and magnetic resonance imaging may be required to evaluate for a malignant cause or if there are neurological deficits on examination 2.
- Management is multimodal in nature and starts with conservative therapy consisting of analgesic medication, medication for osteoporosis, physical therapy, and bracing 4, 3.
- Patients who are refractory to conservative management may be candidates for vertebral augmentation through either vertebroplasty or kyphoplasty 5, 4, 6, 3.
Key Differences
Since there is no direct comparison between vertebral body compression fractures and burst fractures in the provided studies, we cannot outline the major differences between the two. Burst fractures are not discussed in the provided evidence.
Management and Treatment
The management and treatment of vertebral compression fractures are well-discussed in the provided studies:
- Initial management is nonoperative with pain management and bracing 6.
- Patients with persistent back pain and bone marrow edema on magnetic resonance imaging may benefit from injection of cement into the fractured vertebral body with either vertebroplasty or kyphoplasty 6.
- Percutaneous vertebral augmentation, including vertebroplasty and kyphoplasty, is controversial, but can be considered in patients with inadequate pain relief with nonsurgical care or when persistent pain substantially affects quality of life 3.