Case key points

• Vertebral compression fractures are a specific subtype of spinal flexion fractures. They are caused by axial compression forces, leading to fracture and height loss of the anterior part with the posterior part remaining intact. They are considered stable, in contradiction to most of the more severe burst fractures (the other subtype of hyperflexion spinal injury pattern).
• Symptoms and signs of spinal fractures are often delayed and some patients may not demonstrate any neurological abnormality at all. 
• While computed tomography CT is considered the gold standard in diagnosing and characterizing the fracture type, radiographs are often used for screening.
• More or less subtle radiographic signs of vertebral compression fracture may be visualized on both the lateral and anteroposterior radiographs of the spine (deviation of paraspinal line in thoracic fractures, increased interpedicular distance in all fractures)
• To distinguish between the simple wedge compression fracture and a burst fracture, the posterior vertebral body cortex or posterior vertebral cortex should be identified; the term "stable injury" should only be applied to minimal to moderate height loss (<50%) and overtly intact posterior cortex. Holding threshold for CT low may be prudent.
   
• By far the majority of spinal compression fractures occur at the thoracolumbar junction.
• While osteoporosis is the most common etiology of vertebral compression fractures, trauma, infection and neoplasm can also lead to these type of fractures.

Acknowledgements: special appreciation and thanks to Dr Matt Skalski for the terrific illustrations.