As always, the physical examination of a fractured vertebra is the first step in any diagnosis. A vertebral fracture can almost invariably trigger pressure and knocking pains. An examination of spinal mobility should not be carried out at first, in order not to provoke fragment displacement in unstable fractures.
An orienting neurological examination (sensitivity, arbitrary motor activity) must always be performed to obtain indications of possible spinal cord injuries at an early stage. The conventional x-ray follows the physical examination. It is advisable to set the indication for the spinal radiographs generously and not just to X-ray the most troublesome part of the vertebral body.
In the case of considerable violence that could lead to a vertebral fracture (fall injuries, traffic accidents, etc. ), it is recommended to x-ray the entire spinal column. The fear of harmful X-rays is almost always exaggerated and unfounded.
It can have far more consequences if a spinal fracture is overlooked. Classical x-rays of the spine are always taken in two planes when diagnosing a vertebral fracture, when viewed from the front (a. p. image) and from the side. They should therefore be taken:
- Cervical spine in 2 levels
- Thoracic spine in 2 levels
- Lumbar spine in 2 levels
Collapse of the top and base plate (sinter fracture) in osteoporosis with development of a short-distance kyphosis (hunchback).
If several vertebral bodies break in this way, the so-called “widow’s hump” is formed, which is characterized by a very pronounced hunchback. Most vertebral body fractures can be reliably diagnosed on the x-ray images and an initial assessment of a stable or unstable fracture can be made. If an unstable fracture can be safely ruled out, further diagnosis is not necessary.
The typical picture of a stable fracture is the wedge vertebra with a collapsed vertebral front edge with an intact vertebral rear edge. Unstable fractures are not always immediately visible in an X-ray image (example: unstable fracture). If an unstable fracture is suspected, further clarification is required. Better than with any other imaging method, the extent of the fracture of a vertebral body and thus an assessment of its stability can be determined by means of computer tomography (CT).
