Compression fractures

1. What make up the anterior, middle, and posterior columns of the spine? Which ones lead to instability with compression fractures?
2. Where do compression fractures of the spine usually occur?
3. What factors contribute to compression fractures?
4. What is the clinical presentation?
5. How are compression fractures diagnosed?
6. What is the treatment?

Answers:
1. Anterior (stable): ALL, ant 2/3 of vertebral body. Middle (unstable): PLL and post 1/3 of vertebral body. Posterior (stable): Lig flavum, supra and infraspinous ligs, posterior elements (pedicles, facets, spinous process).
2. Thoracolumbar junction.
3. Trauma, osteoporosis, osteomalacia, medications (steroids), neoplasm.
4. Sudden onset of constant thoracolumbar pain, exacerbated by valsalva, turning in bed, incidental trauma.
5. X-rays (vertebral body wedging), bone scan with SPECT, CT, MRI.
6. If <25%>50% vertebral height decr, instability, or kyphotic deformity causing neurologic compromise.