From the Guidelines
Pathologic burst fractures are primarily caused by underlying bone weakening conditions, with metastatic cancer being the most common etiology, as well as other conditions such as multiple myeloma, lymphoma, primary bone tumors, osteoporosis, spinal infections, and systemic conditions like hyperparathyroidism. These conditions compromise the structural integrity of the vertebral body, causing it to collapse and fragment under compressive forces that healthy bone would normally withstand 1. The fracture pattern typically involves the vertebral body bursting outward in multiple directions, potentially causing spinal canal compromise and neurological deficits.
Etiologies of Pathologic Burst Fractures
- Metastatic cancer, particularly from primary tumors of the breast, lung, prostate, kidney, and thyroid that spread to the spine
- Multiple myeloma and lymphoma
- Primary bone tumors
- Metabolic bone diseases such as osteoporosis, especially in postmenopausal women and elderly individuals
- Spinal infections like osteomyelitis or tuberculosis (Pott's disease)
- Systemic conditions such as hyperparathyroidism that affect bone metabolism
Early identification of the underlying cause is essential for appropriate treatment, which often requires addressing both the fracture and the primary disease process. A multidisciplinary approach, including interventional radiology, surgery, and radiation oncology consultation, may be recommended for patients with pathologic fracture, particularly those with severe and worsening pain, spinal deformity, pulmonary dysfunction, or neurologic effects 1.
Importance of Early Identification and Treatment
- Early identification of the underlying cause is crucial for appropriate treatment
- Treatment often requires addressing both the fracture and the primary disease process
- A multidisciplinary approach may be recommended for patients with pathologic fracture, particularly those with severe and worsening pain, spinal deformity, pulmonary dysfunction, or neurologic effects.
From the Research
Etiology of Pathologic Burst Fracture
The etiology of a pathologic burst fracture can be attributed to various factors, including:
- Bone metastases, which are the most common cause of pathological fractures in patients with cancer 2
- Benign bone tumors, such as osteochondromas, chondromas, and giant cell tumors 2, 3
- Malignant bone tumors, such as osteosarcomas, chondrosarcomas, and Ewing's sarcomas 2, 3, 4
- Bone cysts, such as solitary bone cysts and aneurysmal bone cysts 2, 3, 4
- Osteoporosis, which can cause a reduction in bone mass and quality, leading to an increased risk of fracture 4, 5
- Other conditions, such as osteomalacia, osteonecrosis, and Paget's disease, which can affect bone quality and increase the risk of fracture 5
Diagnostic Considerations
Diagnosing the underlying cause of a pathologic burst fracture is crucial for determining the appropriate treatment. This can be achieved through:
- Clinical evaluation, including a thorough medical history and physical examination 2, 5
- Radiological imaging, such as X-rays, CT scans, and MRI scans, to visualize the fracture and underlying bone lesion 2, 3, 4
- Histological examination, such as biopsy, to confirm the diagnosis of a benign or malignant bone tumor 2, 4