Spine frracture pada

osteoporosis
Tutuko radite p n
Pembimbing dr nidaul khasanah sp
Rad

Vignette
A 72-year-old woman presents with a 2-month history
of increasing pain in her lower back, which has not
improved with ibuprofen and is causing difficulty with
walking and dressing. She reports having lost about 5
cm (2 in.) of height since she was a young woman. On
examination, there is mild kyphosis in her lower
thoracic spine but no point tenderness. A lateral spine
radiograph reveals that the L2 vertebra is biconcave in
appearance, a finding that is consistent with a
vertebral fracture (Fig. 1).
How should this case be managed?

Normal Height

T12

Normal Height

L1

Loss of Height

L2

L3

A poorly defined dense

(white) fracture line is visible
with a detached fracture
fragment (asterisk)
L2 has lost height anteriorly
and there is disruption of the
anterior column only

http://www.radiologymasterclass.co.uk/tutorials/musculoskeletal/x-ray_trauma_spinal/x ray_thoracolumbar_spine_fracture.html#top_10th_img

http://www.radiologymasterclass.co.uk/tutorials/musculoskeletal/x-ray_trauma_spinal/x ray_thoracolumbar_spine_fracture.html#top_10th_img

http://www.radiologymasterclass.co.uk/tutorials/musculoskeletal/x-ray_trauma_spinal/x ray_thoracolumbar_spine_fracture.html#top_10th_img

Verterbrae Fracture
1. deformities of the vertebral bodies identified
with imaging of the lateral spine and
characterized according to shape are the
most common manifestation of osteoporosis.
2. Identically with backpain
3. The most place are; thoracolumbar transition
zone or mid thoracic region
4. Less to clinically diagnosed
1. Riggs BL, Melton LJ III. The worldwide problem of osteoporosis: insights afforded by epidemiology. Bone 1995;17: Suppl:505S-511S.
2. Cooper C, Atkinson EJ, OFallon WM, Melton LJ III. Incidence of clinically diagnosed vertebral fractures: a populationbased study in Rochester, Minnesota, 1985-1989. J
Bone Miner Res 1992;7:221-7.

Goals
likelihood of back pain:
Increase the quality of life
clinical diagnosis increase with the severity
and number of fractures
Prevent Fracture-related disability may also be
greater among patients with lumbar fractures
than among those with thoracic fractures
3. Fink HA, Milavetz DL, Palermo L, et al. What proportion of incident radiographic vertebral deformities is clinically diagnosed and vice versa? J Bone Miner Res
2005;20:1216-22.
4. Ettinger B, Black DM, Nevitt MC, et al. Contribution of vertebral deformities to chronic back pain and disability. J BoneMiner Res 1992;7:449-56.

Evaluation
A womans first vertebral fracture usually
occurs well past menopause.
Physical examination may reveal excess
sagittal convexity of the thoracic spine
(hyperkyphosis,
or
dowagers
hump),
especially among patients with multiple
anterior wedge fractures of the thoracic spine.

Prevalention
The prevalence and incidence of radiographic
vertebral fractures increase with age, with the
prevalence among white women rising from
5% to 10% between the ages of 50 and 59
years and to 30% or more at 80 years of age or
older.

clinical risk factors

for incident vertebral fractures :
1. Prior fracture
2. history of one or more falls
3. Inactivity
4. current smoking,
5. use of systemic glucocorticoids
6. certain chronic medical conditions
7. low body-mass index.

Bone mineral density

Measured by x ray absorbtiometry (DEXA)
> 1-3rd of postmenopausal women with
prevalent radiographic vertebral fractures
have T scores (spine and hip) > 2.5
The prevalence of radiographic vertebral
fractures among women 60 years of age or
older with low bone mass has been reported
to range from 14 to 18%

Diagnosis
medical history and an examination may
confirmed with a spinal imaging study.
Lateral thoracic and lumbar spinal radiographs
continue to be the standard for assessment

Genant et al
The method uses the qualitative features of
vertebral shape and degree of reduction in
vertebral height in the anterior, middle, or
posterior vertical dimension to grade a
vertebral body as normal, uncertain regarding
fracture, or characterized by a mild, moderate,
or severe fracture

Treatment

Pain management
Rehabilitation
Vertebroplasty and Kyphoplasty
Calcium and Vitamin D
Pharmacotherapy

Treatment

Pain management
Rehabilitation
Vertebroplasty and Kyphoplasty
Calcium and Vitamin D
Pharmacotherapy

Treatment

Pain management
Rehabilitation
Vertebroplasty and Kyphoplasty
Calcium and Vitamin D
Pharmacotherapy

Treatment

Pain management
Rehabilitation
Vertebroplasty and Kyphoplasty
Calcium and Vitamin D
Pharmacotherapy