There are two elements of surprise in vertebral fracture. The first element is the initial trauma that causes the fracture. A second element is the "catch" type of pain with any movement of the spine.....
78 year young lady chronic smoker fell and had a sudden onset local lower back pain without leg pain. The pain was excrutiating in the beginning. Cough or sneeze or turning her back is very painful.
She has percussion tenderness over her lower back.
X Ray and MRI showed evidence for mild compression fracture at L4 superior plate.
Diagnosis: acute L4 fracture
Treatment: bedrest, protein rich diet, Calcium, Vit D supplement, Biphosphonate, or parathyroid hormone supplement. Pain medication Over-the-counter type helped. LSO brace with daily activity
Outcome: 50% pain reduction in 2 weeks. Walking around with a walker with only moderate pain.
88 year young active farmer fell from his tractor about 2 months ago and developed a sharp severe mid to lower back pain whenever he moves. He noticed the pain is worse when he suddenly coughs or sneezes. The pain is better lying or sitting still.
He had pain in mid back.
X ray/CT/MRI showed acute T12 fracture with >75% height loss.
Diagnosis: as above
Treatment: Bed rest, pain medication, semi-rigid back brace for spine stabilization, Calcium, Vit D, bisphosphonate supplement, or Parathyroid hormone infusion treatment to promote bone healing and recovery.
91 year young lady previously health lifted furniture in her balcony to rearrange. She developed a heavy and sharp lower back pain right then. The pain is worse with any movement. Cough sneeze or laughing or bending forward makes it worse. She denies weakness, numbness nor incontinence.
Diagnosis: lumbar vertebral fracture
X ray confirmed a new L3 fracture
Treatment: Bedrest, back brace, nutritional support, biphosphanate, calcium, Vit D supplement.
81 year young lady chronic back pain with sudden worsening over the past 4 weeks without a history of trauma or fall/injury. She had a recent hospitalization x 1 week and was discharged right before consultation. She denies weakness/numbness/ incontinence. She has remote history of breast cancer 23 years ago. The pain is severe but local to her lower back. Any motion, particularly standing up or sitting up or turning in bed or twisting her back aggravates her back pain. Lying flat or sitting perfectly still helps the pain.
A X ray and MRI showed acute L2 vertebral fracture with >2/3 height loss. A nuclear bone scan whole body showed no other bone fracture or lesion. She is put on back brace, pain medication and bed-rest. She improved.
67 year young woman mid-back to lower back pain - mainly on the right side for three weeks.
She reports minimal pain when she is lying or sitting still or when she walks. It started after she turned back to buckle up a child in the car.The most severe back pain happens when she tries to sitting up from lying flat in bed. She can not sitting up due to the severe pain.
MRI: acute Thoracic 12 fracture.
She was fit into semi-rigid back brace for stability. The back pain is down to 2/10 from 10/10.
She is also considering parathyroid hormone supplement and possible bisphosphonates supplement.
83 year-young lady lifted a bag of potting soil and developed a sudden lower back pain two days ago.
Any intentional or involuntary back movement makes the pain worse.
Even cough, sneeze, laugh, defecation make the pain worse.
A diagnosis of vertebral fracture was made on history. She was fitted in a lumbar sacral orthesis to stablize her spine.
A lumbar spine Xray showed evidence for degenerative disc diseases but no evidence for fracture.
A MRI showed evidence for acute L2 vertebral fracture.
She is also considering parathyroid hormone supplement and vertebroplasty.
84 year young man lifted a 80-lbs salt bag, heard a crack in his back with sudden, sharp, severe, non shooting pain. The pain is motion related and any movement makes it much worse. Cough, sneeze, bending, defecation all makes it worse. Getting up from sleep is unbearably painful. Sitting or lying perfectly still helps.
He had non-focal examination.
Lumbar MRI showed acute L2 vertebrae fracture with disruption of bony cortex and loss of continuity.
Treatment: Bed-rest, pain medication, Calcium, Vit D, biphosphonate supplement, high protein diet...etc. His pain much improved in 4 weeks and resolved in 12 weeks.