Tobert Daniel G, Schwab Joseph H
Instr Course Lect. 2019;68:585-591.
Vertebral compression fractures commonly occur as sequelae to osteoporosis, malignancy, infection, or trauma. Although all compression fractures have an underlying pathology, the term pathologic vertebral compression fracture (pVCF) is traditionally reserved for fractures that result from primary or metastatic spine tumors. Discriminating a pVCF from osteoporotic vertebral compression fractures is important because the subsequent diagnostic workup and therapeutic plan differ substantially between the two etiologies. A carefully obtained history inquiring about high-risk symptomatology and a thorough review of the radiographic data are the cornerstone of making the correct diagnosis. If history and imaging increase the suspicion for pVCF, the subsequent workup is dependent on whether the pathologic spine fracture represents a newly discovered malignancy with spinal metastasis, known malignancy without previous metastasis, or progression of known metastatic disease. Management strategies for pVCF hinge on the neurologic and biomechanical stability of the patient along with the patient's pain and functional mobility. Surgeons should be familiar with the diagnosis and treatment of pathologic vertebral compression fractures caused by metastatic disease.
椎体压缩性骨折通常是骨质疏松症、恶性肿瘤、感染或创伤的后遗症。虽然所有压缩性骨折都有潜在的病理基础，但传统上病理性椎体压缩性骨折（pVCF）一词仅用于由原发性或转移性脊柱肿瘤导致的骨折。区分pVCF和骨质疏松性椎体压缩性骨折很重要，因为这两种病因的后续诊断检查和治疗方案有很大差异。仔细询问高危症状的病史并全面审查影像学数据是做出正确诊断的基石。如果病史和影像学检查增加了对pVCF的怀疑，后续检查取决于病理性脊柱骨折是代表新发现的伴有脊柱转移的恶性肿瘤、既往无转移的已知恶性肿瘤还是已知转移性疾病的进展。pVCF的治疗策略取决于患者的神经和生物力学稳定性以及患者的疼痛和功能活动能力。外科医生应熟悉转移性疾病所致病理性椎体压缩性骨折的诊断和治疗。
