Vertebral body pathological fracture

Last revised by Dr Daniel J Bell on 14 Jul 2021

Vertebral body pathological fracture​ occurs as a result of infiltration of the vertebral body by a neoplastic process (primary or secondary). Vertebral bodies are one of the most common sites of pathological fractures.

As with other types of vertebral fractures, they present with pain and loss of mobility. If there is a spinal cord or nerve root compression, respective neurologic deficits occur.

It is sometimes hard to differentiate between malignant and acute osteoporotic vertebral fractures, especially in elderly patients with known malignancy, as both types of fracture are prevalent in this population.

Features that favor pathological fractures are:

  • fracture with bony destruction (on CT)
  • replaced signal of the vertebral body, especially extending into the pedicles or posterior elements (on MR)
  • convex bulging (not retropulsion) of the posterior vertebral cortex into the spinal canal
  • epidural or paraspinal mass 
  • other vertebral metastases

Contrast enhancement of the fractured vertebral body was in some studies 1 not helpful in differentiating between osteoporotic and metastatic vertebral fractures, as they both usually present with heterogeneous, intense enhancement.

Accurate reporting of malignant vertebral fracture is important, as the diagnosis may affect the disease staging and treatment as well as the patient's prognosis.

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