Review Question - QID 214887

Vertebral compression fractures are a common type of fracture often occurring at the mid-thoracic spine level and at the thoracolumbar junction. They are commonly seen in young men due to trauma, or in elderly women most often due to osteoporosis. In our patient with multiple risk factors for osteoporosis including female sex, advanced age and remote history of hysterectomy, a vertebral compression fracture is the most likely diagnosis. Clinical features of acute vertebral compression fractures include point tenderness at the affected level, and lower back pain worsened with mobility and laying down. Fractures can be stable (no neurological deficits) or unstable (spinal cord involvement). Diagnosis can be made with an anterior-posterior and lateral radiograph, and MRI is indicated if spinal cord involvement is suspected.

Incorrect Answers
Answer 1: Ankylosing spondylitis is a chronic type of seronegative spondyloarthropathy and would be an unlikely diagnosis in this elderly woman with acute presentation of back pain. It is typically seen in younger males aged 15 – 40 and the pain improves with activity without point tenderness.

Answer 2: Herniated disc is a type of degenerative disc disease that is typically caused by extrusion of the nucleus pulposus against a spinal nerve. While a herniated disc can present with pain after lifting heavy objects, it is typically also associated with loss of deep tendon reflexes as well as the presence of dermatomal pain due to compression of the spinal root.

Answer 3: Lumbar Spinal Stenosis is a progressive narrowing of the lumbar spinal canal leading to radiating back pain typically improved by activities that cause spinal extension (pushing a shopping cart, walking downhill). It would be an unlikely diagnosis in a woman with an acute presentation of back pain with point tenderness worsened by all activity.

Answer 4: Metastatic cancer to bone from primary malignancies of other organs should always be suspected in an elderly woman with localized back pain. They may present with signs of spinal cord compression and require emergent surgery. However, given this patient’s history of heavy lifting and acute presentation of back pain, a compression fracture is a more likely diagnosis.