Spine fracture with neurological deficit in osteoporosis

The literature suggests that spinal fractures acquired after minimal trauma in osteoporotic patients cause neurological problems only extremely rarely. This report describes 9 patients with severe osteoporosis in whom minimal trauma led to a fracture of the thoracic or lumbar spine causing significant neurological deficit. All patients presented originally with isolated back pain after minimal trauma. Initial radiographs documented what appeared to be 'benign' compression fractures with minimal loss of vertebral height. Over the following 1-12 weeks all patients described a gradual onset of severe radicular pain which was subsequently associated with profound lower extremity weakness in 7 cases. Repeat radiographs revealed advanced collapse of the fractured level. CT and MRI images revealed violation of the posterior cortex of the vertebrae with retropulsion of bone into the spinal canal. In 2 cases, two simultaneous fractures of this kind were noted; in both of these cases the fractures occurred at adjacent levels. The upper lumbar spine was most frequently involved. This relatively small series suggests that caution should be used in the assessment of benign-appearing compression fractures in osteoporotic patients. The delayed appearance of neurological signs and symptoms may lead to a late or missed diagnosis. The onset of back pain in an elderly patient quite frequently represents the acquisition of a fracture; subsequent complaints of leg pain or lower extremity dysfunction may indicate progression of such a fracture, with compromise of the neutral elements.