Are compression deformities of the spine the same as compression fractures?

Compression Deformities vs. Compression Fractures of the Spine

Compression deformities and compression fractures of the spine are essentially the same clinical entity, representing vertebral body collapse due to compromised bone integrity, most commonly from osteoporosis. 1

Understanding Vertebral Compression Fractures (VCFs)

Vertebral compression fractures (VCFs) result in deformation of the vertebral body and are the most common type of fracture secondary to osteoporosis. These fractures can present as:

• Biconcave deformities
• Anterior wedge deformities
• Crush deformities 2

The term "compression deformity" is often used interchangeably with "compression fracture" in clinical practice, particularly when describing the radiographic appearance of the collapsed vertebra. Both terms refer to the same pathological process - the collapse of a vertebral body due to axial loading forces that exceed the strength of the bone.

Clinical Significance

The clinical importance of these vertebral deformities/fractures includes:

• Pain (typically acute and severe initially, lasting 2-3 months) 2
• Spinal deformity (kyphosis)
• Decreased physical functioning
• Impaired quality of life
• Increased mortality 3

Diagnostic Considerations

When evaluating a patient with suspected vertebral compression fracture/deformity:

• Plain radiographs or CT can identify the compression deformity/fracture 1
• MRI is valuable for:
  • Determining acuity (presence of edema)
  • Differentiating between benign and malignant causes
  • Identifying fracture clefts
  • Assessing for neural compression 1

Management Approach

Acute Management (0-3 months)

1. Medical management is the first-line approach for most uncomplicated vertebral compression fractures/deformities 1

   • Pain control (NSAIDs, analgesics)
   • Limited bed rest
   • Bracing for comfort
   • Gradual return to activity

2. Consider early vertebral augmentation for:

   • Severe pain unresponsive to medications
   • Significant spinal deformity
   • Pulmonary dysfunction 1

Chronic Management (>3 months)

1. For persistent pain after 3 months of conservative treatment:

   • Vertebral augmentation (vertebroplasty or kyphoplasty) should be considered 1

2. For pathologic fractures (due to malignancy):

   • Multidisciplinary approach involving interventional radiology, surgery, and radiation oncology 1

Special Considerations

• Neurological deficits: Surgical consultation is warranted immediately 1
• Malignant vs. osteoporotic causes: MRI can help differentiate between these etiologies 1
• Spinal instability: The Spinal Instability Neoplastic Score (SINS) can guide management in cases of metastatic disease 1

Key Pitfalls to Avoid

1. Failing to identify red flags suggesting pathologic fracture:

   • History of malignancy
   • Unexplained weight loss
   • Night pain
   • Fever

2. Delaying treatment in patients with:

   • Neurological deficits
   • Progressive deformity
   • Severe, unrelenting pain

3. Overlooking underlying osteoporosis - all patients with compression fractures/deformities should be evaluated and treated for osteoporosis 4

In summary, whether termed a compression deformity or compression fracture, the clinical entity represents the same pathological process requiring the same diagnostic and therapeutic approach. The focus should be on pain management, preventing further deformity, and treating underlying causes.