Non-osteoporotic multilevel contiguous vertebral compression: a rare clinical case report

Multiple-level contiguous vertebral compression fractures (VCFs) are typically associated with osteoporosis or pathological conditions. The occurrence of such fractures in individuals with normal bone mineral density following high-energy trauma is exceedingly rare.

We report the case of a 64-year-old male construction worker who sustained a fall from a height of approximately 4 meters, landing on his feet. He presented with severe back and right heel pain but exhibited no neurological deficits. Imaging studies revealed acute compression fractures at L1, L2, and L3 vertebral bodies, with the most significant collapse at L2. Additionally, a displaced intra-articular fracture of the right calcaneus was identified. Bone mineral density assessment demonstrated normal bone health (T-score: 0.3). The patient underwent open reduction and internal fixation (ORIF) for the calcaneal fracture and posterior spinal instrumentation spanning T12 to L4 to stabilize the spinal injuries. At the 1-year follow-up, he returned to full activity without neurological deficits, and imaging confirmed successful fracture healing.

This case highlights a rare pattern of traumatic multilevel contiguous vertebral compression fractures with preserved bone mineral density and an associated calcaneal fracture. Such spinal injury patterns are rarely reported and underscore the need for high suspicion even in patients with normal bone health. A comprehensive evaluation, including bone density assessment and thorough imaging, is essential to differentiate these cases from fractures caused by underlying pathologies. In patients with unstable fractures, progressive collapse, or high functional demand, early surgical intervention can promote stabilization and recovery, as demonstrated in this case.