A novel radiological assessment to identify acute vertebral compression fractures: A pilot observational study

The diagnosis of acute vertebral compression fractures (AVCFs) is often challenging. An alternative to magnetic resonance imaging, which may not always be available, includes a comparison of supine and sitting/standing position radiographs. However, this cannot be accomplished in patients with acute vertebral compression fractures who require emergency transport and are in severe pain. In this study, aimed to assess the diagnostic accuracy of comparing lateral-view radiographs of the thoracolumbar spine in supine and 30° head-elevated positions, which are less painful.

We retrospectively examined 30 patients with AVCFs who were transported by ambulance to our emergency department between June 2018 and May 2019. All underwent 30° head-elevated lateral-view thoracolumbar spine radiography and magnetic resonance imaging. We evaluated vertebral fractures by examining changes in vertebral wedging ratio (WR) from supine to 30° head-elevated position (Δ WR) using the following equation: Δ WR = WR (30° head-elevated) - WR (supine). We compared Δ WR to that of unfractured vertebrae as control.

A total of 176 vertebrae were included (fractured, 32 and non-fractured, 144). Δ WR of fractured vertebrae ranged between 5.1% and 24.4%, whereas non-fractured vertebrae ranged between -6.7% and 4.3%. Median Δ WR of fractured vertebrae was significantly higher than non-fractured vertebrae (12.6% versus -0.5%, p < 0.001). No patients reported pain during 30° head-elevated positioning.

Lateral radiographs in supine and 30° head-elevated positions can accurately diagnose of AVCF, without worsening pain. This study showed a Δ WR value of ≥5.1% for AVCFs.