Osteoporosis with vertebral compression fractures, retropulsed fragments, and neurologic compromise

Osteoporosis frequently affects the vertebral column and causes compression fractures, biconcave ("fish-mouth") vertebrae, kyphosis, and pain. The cases are reported of three postmenopausal osteoporotic women who had neurologic symptoms of the lower extremities because of vertebral body fractures with a retropulsed fragment narrowing the spinal canal. None of the women had experienced trauma. The fractures resembled burst-type fractures that result from axial loading with major trauma. The retropulsed fragments could be seen best on computed tomographic or magnetic resonance images and were very subtle on conventional radiographs, on which an abnormal posterior vertebral body line was the only abnormality detected. This complication of osteoporosis of the spine is important to recognize so that appropriate treatment can be instituted.