Vertebral compression fractures are most commonly low-energy injuries that occur in patients with underlying osteopenia or osteoporosis. They affect between 700,000 and 1,000,000 persons in the US annually, and 25% of woman in their lifetime.1^,2 Many low-energy fractures are treated nonsurgically with a short period of bed rest, pain medications, bracing, and therapy. Approximately 30% to 40% of patients, however, develop disabling pain and/or deformity (kyphosis), resulting in 150,000 hospitalizations annually. Frequently, patients with VCF also have reduced pulmonary function (FVC), increased risk of mortality (compared to age-matched controls), and a lower 5-year survival when compared to hip fracture patients.3 Treatment of symptomatic VCF with vertebral augmentation (vertebroplasty or kyphoplasty) has been shown in various studies to be a cost-effective intervention that both decreases pain and improves survival.4^,5^,6 Various strategies have been employed to prevent and treat the osteoporosis that predisposes to these “fragility fractures” and is further discussed in the Osteoporosis chapter.

• 1. Edidin AA, Ong KL, Lau E, Kurtz SM: Life expectancy following diagnosis of a vertebral compression fracture. Osteoporosis Int 2013 Feb;24(2):451-458.
• 2. Riggs BL, Melton LJ: The worldwide problem of osteoporosis: Insights afforded by epidemiology. Bone 1995;5055–5115.
• 3. Kado DM, Browner WS, Palermo L, Nevitt MC, Genant HK, Cummings SR: Vertebral fractures and mortality in older women: A prospective study. Study of Osteoporotic Fractures Research Group. Arch Intern Med 1999;159,1215–1220.
• 4. Svedbom, A, et al: Balloon kyphoplasty compared to vertebroplasty and nonsurgical management in patients hospitalized with acute osteoporotic vertebral compression fracture: a UK cost-effectiveness analysis. Osteoporos Int, 2012.
• 5. Garfin SR, Reilley MA: Minimally invasive treatment of osteoporotic vertebral body compression fractures. The Spine Journal 2002(2):76-80.
• 6. Edidin AA, Ong KL, Lau E, Kurtz SM: Mortality risk for operated and non-operated fracture patients in the Medicare population. JBMR, 2011 Jul;26(7):1617-1626.

Traumatic spine fractures are usually high-energy injuries that typically involve young, male patients. Most injuries are the result of high-energy falls (35% to 40%), followed by traffic accidents (20% to 30%), and low-energy falls (20% to 25%).1^,2^,3^,4 Approximately one-half involve the thoracolumbar spine (T12–L2), while 20% involve the cervical spine. Neurologic injury occurs in 16% to 25% overall, but in as many as 40% of cervical fractures. There are approximately 12,000 spinal cord injuries each year,2^,3 which are associated with a significant mortality rate. Fractures without neurologic injury generally occur three times more frequently, with an estimated 36,000 traumatic spine fractures each year. Most traumatic spine fractures are treated nonsurgically with a one- to three-month period of immobilization and bracing. Unstable fractures and those with neurologic impairment may require surgical treatment, extensive rehabilitative services, and often develop long-term disability.
   

• 1. P Leucht, K Fischer, G Muhr, EJ Mueller: Epidemiology of traumatic spine fractures Injury 2009 Feb;40(2):166-172.
• 2. a. b. Wang H, Zhang Y Xiang Q, et al: Epidemiology of traumatic spinal fractures: experience from medical university-affiliated hospitals in Chongqing, China 2001–2010. J NS Spine 2012 17:459-468.
• 3. a. b. National Spinal Cord Injury Statistical Center: Spinal Cord injury facts and figures at a glance. http://www.spinalcord.uab.edu [1].Accessed January 11, 2015.
• 4. Riggins Rs, Kraus JF: The risk of neurologic damage with fractures of the vertebra. J Trauma 1977;17(2):126-133.

Based on the HCUP Nationwide Inpatient Sample (NIS) and Nationwide Emergency Department Sample (NEDS) databases queried, there were an estimated 795,300 hospital discharges and emergency department visits for spinal fractures in 2010–/2011. Nearly three out of five spinal fractures occurred in women.

The great majority of hospital/ED combine spinal fracture patients (773,000, or 97%) were treated for vertebral compression fractures (VCF), and more than one-half (58%) involved women. Nearly half of discharges and visits for VCFs were for persons age 75 years and older.

Traumatic fractures were far less common, with 27,100 (3%) hospital discharges or outpatient visits reported in the 2010–2011 Heathcare Cost and Utilization (HCUP) databases. Numbers were too small for reliable reporting in the National Center for Health Statistics (NCHS) databases, which include outpatient and physician office visits. Traumatic fractures predominantly involve men (about 60%), and are most likely to involve patients between the ages of 18 and 44 years. These are coarse estimates, as some ED patients are admitted (samples may overlap and overestimate), while outpatient visits are not included. (Reference Table 3.1.1 PDF [2] CSV [3] and Table 3.1.2 PDF [4] CSV [5])

The average length of stay for those patients discharged from hospitals with a spine fracture diagnosis was 6.8 days, with an average charge of $69,500. The charges for both males and younger patients were 30% to 60% higher than the average. Similarly, the length of stay was higher in younger patients (8 days or more), and gradually decreased with age (6 days for those older than 75 years of age). This correlation most likely reflects the higher association of more complicated traumatic fractures in these younger patient populations. (Reference Table 3.4.1 PDF [10] CSV [11])

Nearly two in three patients seen in the ED with spinal fractures were transferred to a hospital. Patients admitted to the hospital from an emergency department had slightly longer average length of stay (LOS) (7.2 days) and higher charges ($70,700) than those directly admitted to the hospital. Most patients with a primary diagnosis of spine fracture admitted to the hospital from the ED were discharged to a long-term care facility (42%) and another 37% were discharged to home. The likelihood of discharge to a long-term facility was also directly related to age as noted previously. (Reference Table 3.1.2 PDF [4] CSV [5]; Table 3.4.2 PDF [12] CSV [13]; and Table 3.3.2 PDF [14] CSV [15])

The greater severity of traumatic spinal fractures is dramatically illustrated by average hospital stays more than twice as long as for VCFs (14 days vs. 6.6 days), and average charges three times as high ($197,700 vs. $65,700). Differences in LOS and charges are particularly dramatic for persons under the age of 45 years. (Reference Table 3.4.3 PDF [16] CSV [17])

Only a small proportion of patients hospitalized with a spinal fracture undergo surgery. Of the 334,300 hospital admissions in the NIS database, fusion (8.8%) and kyphoplasty/vertebroplasty (10.6%) were the most common procedures performed. Similar rates of procedures were found in the NEDS hospitalized patients and National Hospital Discharge Survey (NHDS) databases. (Reference Table 3.5.1 PDF [18] CSV [19])

The majority of spinal fusion procedures on spine fractures were performed on patients under the age of 44 years, with patients age 65 years and older rarely undergoing surgery for spinal fractures. This is due to a much higher rate of fusion procedures performed on patients with traumatic fractures than on patients with VCFs. (Reference Table 3.5.2 PDF [20] CSV [21])


Fusions were performed most frequently in the cervical spine (41%), followed by thoracic spine (38%) and lumbar spine (26%). On average across the three databases included in the analysis, three out of four fusions performed were on four or fewer levels, with the remaining quarter of procedures involving five or more levels. (Table 3.5.3 PDF [22] CSV [23])

On the average, of 305,600 patients discharged with diagnosis of a vertebral compression fracture, 12% were treated with a kyphoplasty/vertebroplasty procedure. These patients were twice as likely to be female, and were most likely to be 65 or older. (Reference Table 3.5.4 PDF [24] CSV [25])