Retrospective Review of 181 Patients with Pathologic Vertebral Compression Fractures

Background: Compression fractures are often associated with lower energy trauma and may occur in the setting of abnormal bone health associated with genetic disorders and endocrine disorders, neoplastic disease, infection, and inflammatory disorders. There is no significant series in the literature describing the prevalence or etiology of pathologic pediatric compression fractures. Methods: IRB-approved retrospective study was performed at a tertiary children’s hospital from 2012-2022. Patients <18 years old diagnosed with atraumatic vertebral compression fractures were included and reviewed for demographics, underlying diagnosis/comorbidity, presentation, mobility, deformities, imaging data, treatments, and outcomes. Results: 181 patients (54% Male) were included with mean age 14.17 years and follow-up of 20 months. A compression fracture was the presenting symptom of an underlying diagnosis in 32% of patients. Primary osteoporosis was the cause in 15%, and secondary osteoporosis was in 65% of patients; primarily due to immunosuppressants (46%) and ALL (10%). Primary lesions were the etiology in 20% of patients. There was a median of 3 fractures per patient, mostly of the midthoracic (82%) and thoracolumbar spine (51%). Radiographs revealed wedge fractures in 82% and vertebra plana in 11%. Patients were managed with careful observation or bracing (78%) and only 6% received an operation. By last follow-up, more patients developed scoliosis and were wheelchair-bound. Overall, there was a 16% mortality rate which was mostly associated with cancer. Conclusion: About 32% of patients presented with a compression fracture as the presenting symptom of an underlying disease. Pathologic vertebral compression fractures in children frequently occurred due to immunosuppressants, ALL, and metastatic disease. The fractures are often wedge or non-structural in the thoracolumbar and mid-thoracic regions of the spine. MRI’s may be useful for distinguishing between benign fractures and malignancy. Most children were treated by observation, but bracing for kyphosis was often necessary.