Ma. Celina C.

Butalon, MD
Department of Rehabilitation Medicine
Philippine General Hospital
KYPHOSIS

Excessive curvature of
the thoracic spine

Round back deformity

NORMAL KYPHOSIS
Cobb’s Angle

20-40 degrees

Measured from T2-T12

Anterior Wedge Fracture
Anterior part of
vertebral body is
crushed
Middle column intact
Anterior
columndecreased in
height
Posterior
columnunchanged
Majority of damage
limited to anterior
column

Fracturestable

Rarely associated with

neurologic compromise
 Increasing kyphosis angle is independently associated
with worsening mobility. Interventions are needed to
prevent or reduce increasing kyphosis and mobility
decline.

Katzman W, Vittinghoff E, Ensrud K, Black D, Kado D. Increasing kyphosis predicts

worsening mobility in older community-dwelling women: a prospective cohort
study. Jounal of American Geriatric Society. 2011 Jan;59(1):96-100
VERTEBRAL COMPRESSION
FRACTURE
Hallmark of osteoporosis

MODIFIABLE RISK FACTORS

Advanced age
Female gender
Caucasian race
Presence of dementia
Susceptibility to falling
History of fractures in adulthood
History of fractures in a first-degree relative
VERTEBRAL COMPRESSION
FRACTURE
NON-MODIFIABLE RISK FACTORS

Being in an abusive situation

Alcohol and/or tobacco use
Presence of osteoporosis and/or estrogen deficiency
Early menopause or bilateral ovariectomy
Premenopausal amenorrhea for more than one year
VERTEBRAL COMPRESSION
FRACTURE
NON-MODIFIABLE RISK FACTORS

Frailty
Impaired eyesight
Insufficient physical activity
Low body weight
Dietary calcium and/or vitamin D deficiency
Spinal Compression Fracture
Insidious
Produce modest back pain
Multiple fractures  loss of height
Shortening of paraspinal musculature

Prolonged active contraction Maintenance of posture

Pain from muscle fatigue

Thoracic Kyphosis
Develop as vertebral
height is lost

Rib cage presses down

on pelvis
•Impaired
pulmonary
function
Reduced thoracic and
•Protruberant
abdominal space abdomen
•early satiety
•Weight loss
 RADIOGRAPHIC FINDINGS
DIAGNOSIS  Wedge-shaped vertebral body
 Narrowing of anterior portion
COMPRESSION FRACTURE
Decrease in vertebral
height of >20%

Decrease of at least 4 50% decrease

In vertebral
mm compared with height
baseline height
Common location

T8-T12

L1

L4
DIAGNOSIS
20-30% are multiple

May occur at different levels

One to five consecutive vertebral bodies

DIAGNOSIS
CT Scan

Identify fractures not

well visualized in plain
films

Reveal spinal canal

narrowing
DIAGNOSIS
MRI

Spinal cord
compression
DIAGNOSIS
Bone density studies Bone scan
TREATMENT
Determine stability of spine

Stable fracture
 Non operative and conservative

Avoid inactivity

Oral or parenteral analgesics

TREATMENT
Muscle relaxants, external back-braces, and
physical therapy modalities also may help.
[Evidence level B]

Tamayo-Orozco  J, Arzac-Palumbo  P, Peon-Vidales  H, Mota-Bolfeta  R,

Fuentes  F.  Vertebral fractures associated with osteoporosis: patient
management.  Am J Med.  1997;103Suppl:44S–8S
TREATMENT
Braces for Osteoporotic Vertebral Compression Fracture
Jewett Hyperextension Brace
TREATMENT
Braces for Osteoporotic Vertebral Compression Fracture
Molded Jacket or Clam-shell
TREATMENT
Braces for Osteoporotic Vertebral Compression Fracture
Cruciate Anterior Spinal Hyperextension Brace
TREATMENT
Braces for Osteoporotic Vertebral Compression Fracture
Knight Taylor Brace
 TREATMENT
Braces for Osteoporotic Vertebral Compression Fracture
Spinomed

Pfeifer, M., Begerow, B., Minne, H.W. (2004). Effects of a new spinal orthosis on posture, trunk strength, and
quality of life in women with postmenopausal osteoporosis: A randomized trial. Am J Phys Med Rehabil. 83:177–
186.
 
TREATMENT
Percutaneous Vertebroplasty

Injecting acrylic cement

into the collapsed
vertebra

Stabilize and strengthen

the fracture and vertebral
body
TREATMENT
KYPHOPLASTY
cement is injected into a
cavity created by a high-
pressure balloon
Full recovery at 6 to 12 weeks

Return to normal activities after fracture has completely

healed
Three Column Spinal Stability by Denis

•Posterior elements
••Pedicles,
Posterior facets,
1/3 of lamina
Anterior 2/3 ofvertebral
vertebralbody
body
•••Ligamentous
Posterior complex
Annulus
Anterior Longitudinal Ligament
• facet
• Posterior capsules
Longitudinal Ligament
• Ligamentum flavum
• Interspinous ligament
• Supraspinous ligament