Rope Jumping-Induced Traumatic Compression Fractures: the Underestimated Danger of Repetitive Axial Load Forces

A non-osteoporotic adult presented with multilevel compression fractures at the apex of the thoracic kyphosis after strenuous rope jumping. Magnetic resonance imaging demonstrated diffuse bone marrow changes in the vertebral bodies with only a small unilateral endplate fracture. Besides highlighting the oftentimes neglected role of repetitive subpathological axial load forces in traumatic spinal injuries, the observed imaging pattern substantiates previous experimental studies which demonstrated that under cyclic axial loading the initial damage occurs in the cancellous regions of the bone (with observation of cracks with average length between 50-100 μM), ultimately leading to a reduction in its elastic modulus. This pathophysiological mechanism, in which unmitigated propagation of trabecular microscopic cracks through the vertebral bone marrow precedes endplate fractures, may provide a rationale for recent proposals of targeted cement-augmentation in traumatic compression fractures with cement injection directed toward the regions of bone marrow changes.