PATHOLOGICAL SPINE FRACTURES

Symptoms of Pathological Spine Fractures

Symptoms of pathological spine fractures can vary depending on the severity of the fracture and the underlying condition. Common symptoms include back pain that may worsen with movement or coughing.  In addition, there is limited mobility and neurological deficits such as numbness, tingling, or weakness in the arms or legs. In severe cases, patients may also experience loss of bladder or bowel control.

Causes of Pathological Spine Fractures

Pathological spine fractures occur because of various factors, but the most common causes are cancer and osteoporosis. In cancer patients, the tumor can invade the bone and weaken it, making it more susceptible to fracture. In osteoporosis, the bones become brittle and weak, increasing the risk of fractures even with minor trauma.

Osteoporosis is especially common in women who have gone through menopause, making them more prone to compression fractures. However, osteoporotic fractures are not limited to this group—they can also affect individuals with a history of long-term use of steroid medications, as well as those who have undergone chemotherapy or radiotherapy. All of these factors can contribute to weakened vertebrae, setting the stage for pathological spine fractures.

• Osteoporosis

Osteoporosis is the leading cause of pathological spine fractures, particularly in older adults and postmenopausal women. This condition is characterized by decreased bone density and deterioration of bone microarchitecture, making the vertebrae fragile and prone to fracture. In osteoporosis, even minor activities like bending, lifting, or coughing can cause a vertebral compression fracture. According to the National Osteoporosis Foundation, approximately 50% of women and 25% of men over age 50 will experience an osteoporotic fracture in their lifetime, with the spine being the most common site. Estrogen deficiency in postmenopausal women, aging, and risk factors like low calcium intake, smoking, and prolonged corticosteroid use exacerbate bone loss, increasing fracture risk.

• Bone Metastases

Cancer that spreads to the spine (metastatic disease) is a frequent cause of pathological fractures, particularly in patients with breast, lung, prostate, or kidney cancer. Metastatic tumors invade the vertebrae, disrupting bone structure through osteolytic (bone-destroying) or osteoblastic (bone-forming but abnormal) processes. Osteolytic metastases, common in breast and lung cancer, degrade bone through increased osteoclast activity, while osteoblastic metastases, typical in prostate cancer, create brittle, disorganized bone prone to fracture. These fractures often occur with minimal trauma and may present with sudden, severe back pain. The American Cancer Society notes that up to 70% of patients with advanced cancer develop bone metastases, with the spine being a primary site due to its rich blood supply.

• Multiple Myeloma

Multiple myeloma, a cancer of plasma cells in the bone marrow, is another significant cause of pathological spine fractures. This malignancy leads to the production of abnormal proteins that activate osteoclasts, resulting in widespread osteolytic lesions and bone destruction. The vertebrae are commonly affected, with up to 60% of multiple myeloma patients experiencing spinal fractures, according to the International Myeloma Foundation. These fractures can occur spontaneously or with minor trauma, often causing severe pain, spinal deformity (e.g., kyphosis), and, in some cases, spinal cord compression. Hypercalcemia (elevated blood calcium) from bone breakdown further weakens the skeleton, compounding fracture risk.

• Infections (Osteomyelitis)

Spinal infections, such as osteomyelitis, can weaken vertebral bone, leading to pathological fractures. Osteomyelitis occurs when bacteria (e.g., Staphylococcus aureus), fungi, or other pathogens infect the bone, often via hematogenous spread (through the bloodstream), direct inoculation (e.g., surgery), or adjacent soft tissue infection. The infection causes inflammation, bone destruction, and abscess formation, compromising the vertebra’s structural integrity. Tuberculosis of the spine (Pott’s disease) is a notable example, prevalent in endemic areas, where it erodes vertebral bodies, leading to collapse and kyphotic deformity. Fractures in this context may develop gradually as the infection progresses, often accompanied by systemic symptoms like fever and weight loss.

• Metabolic Bone Diseases

Other metabolic conditions, such as Paget’s disease of bone, osteogenesis imperfecta, and hyperparathyroidism, can predispose the spine to pathological fractures. Paget’s disease involves abnormal bone remodeling, creating enlarged but weak vertebrae that are fracture-prone, especially in the lumbar spine. Osteogenesis imperfecta, a genetic disorder, results in brittle bones due to defective collagen, leading to fractures in children and adults, including the spine. Hyperparathyroidism, often due to a parathyroid adenoma, causes excessive parathyroid hormone, which increases bone resorption, leading to generalized bone weakening and a higher risk of vertebral fractures. These conditions disrupt normal bone homeostasis, making the spine susceptible to collapse under minimal stress.

• Primary Bone Tumors

Though less common, primary bone tumors like osteosarcoma, chondrosarcoma, or giant cell tumors can cause pathological spine fractures. These tumors originate in the vertebrae and weaken bone through local destruction or abnormal growth. For instance, osteosarcoma, more common in adolescents, can present with a vertebral fracture as the first sign, though it typically affects long bones. Giant cell tumors, often occurring in young adults, are locally aggressive and may lead to vertebral collapse if located in the spine. These fractures are rare but significant, as they often signal an underlying malignancy requiring urgent evaluation.

• Systemic Conditions and Medications

Certain systemic conditions and long-term medications can indirectly contribute to pathological spine fractures by weakening bone. Chronic kidney disease leads to renal osteodystrophy, where impaired vitamin D activation and secondary hyperparathyroidism cause bone fragility. Similarly, prolonged corticosteroid use (e.g., for autoimmune diseases like rheumatoid arthritis) suppresses osteoblast activity, reducing bone density and increasing fracture risk. Anticonvulsants, chemotherapy agents, and excessive alcohol consumption also impair bone health, creating a predisposition to vertebral fractures. These factors often exacerbate underlying conditions like osteoporosis, amplifying the likelihood of a pathological fracture.

Risk Factors and Mechanisms

The underlying diseases share common mechanisms that weaken the vertebrae, including increased osteoclast activity (bone resorption), decreased osteoblast activity (bone formation), or direct bone destruction by tumors or infection. Risk factors such as advanced age, female gender, prior fractures, low body mass

Diagnosis of Pathological Spine Fractures

Diagnosis of pathological spine fractures typically involves a thorough medical history and physical examination. Doctors will use Imaging tests such as X-rays, CT scans, or MRI scans to confirm the diagnosis and determine the severity of the fracture.

Treatment of Pathological Spine Fractures

Treatment of pathological spine fractures depends on the severity of the fracture and the underlying condition. The doctor will employ Non-surgical treatments, such as pain management and bracing, to treat mild to moderate fractures. Pain management techniques may include over-the-counter pain medications or prescription pain medications, physical therapy, or spinal injections. Doctors will also use bracing to provide support to the affected area and promote healing.

In more severe cases, doctors will recommend surgical intervention. Surgery may be considered if the spine is unstable or where there is significant compression of the spinal cord and/or nerves. Surgery may involve procedures such as vertebroplasty or kyphoplasty, which involve injecting cement into the fractured vertebrae to stabilize the bone and relieve pain. Surgeons will also use spinal fusion to stabilize the spine and prevent further damage.

Prevention Measures

Prevention measures for pathological spine fractures include maintaining a healthy diet rich in calcium and vitamin D to promote bone health, engaging in weight-bearing exercises to strengthen the bones, and avoiding tobacco and excessive alcohol consumption. Patients with underlying conditions such as cancer or osteoporosis should also receive appropriate medical treatment to manage their condition and reduce the risk of fractures.

Recover from Pathological Spine Fractures

The recovery time for pathological spine fractures can vary depending on the severity of the fracture and the treatment approach. Patients undergoing non-surgical treatments may experience relief from pain and improved mobility within several weeks to several months. Patients undergoing surgical intervention may require a longer recovery period and may need to limit physical activity for several months after the procedure.

Conclusion

In conclusion, pathological spine fractures are a type of fracture that occurs in the spinal column due to underlying pathological conditions such as cancer or osteoporosis. As a result, symptoms of pathological spine fractures can include back pain, limited mobility, and neurological deficits. Diagnosis typically involves a thorough medical history and imaging tests such as X-rays, CT scans, or MRI scans. Treatment options include non-surgical interventions such as pain management and bracing Additionally, surgical interventions such as vertebroplasty, kyphoplasty, or spinal fusion surgery are performed.

Prevention measures include maintaining a healthy diet.  Also, engaging in weight-bearing exercises to promote bone health and receiving appropriate medical treatment for underlying conditions definitely help. Recovery time can vary depending on the severity of the fracture and the treatment approach.  Non-surgical treatments typically require several weeks to several months while surgical interventions require a longer recovery period to recover.

Your Child Deserves the Very Best Pediatric Orthopedic Doctors for their Spine

Selecting a pediatric orthopedic doctor for your child is a crucial decision that requires careful consideration. By seeking recommendations, researching credentials, assessing hospital affiliations, reviewing patient testimonials, evaluating communication and bedside manner, considering the supportive team, discussing treatment options, seeking second opinions, prioritizing accessibility, and trusting your instincts, you can make an informed choice. Remember, finding the right orthopedic doctor will ensure that your child receives the best possible care, leading to optimal outcomes and a healthier, happier future. Importantly, the Medical City Children’s Orthopedics and Spine Specialists doctors only treat children.  With offices in Arlington, Dallas, Flower Mound, Frisco, and McKinney, TX. doctors Shyam Kishan, Richard Hostin, and Kathryn Wiesman have spent years studying children’s health and have devoted their lives to treating them. Finally, we invite you to give us a call and make an appointment for your child.

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Footnote:

National Institute of Health: Pathological Fractures