Vertebral fractures

Last updated: November 10, 2023

Summarytoggle arrow icon

Vertebral fractures can be caused by direct or indirect trauma and are more likely to occur in patients with decreased bone density (osteoporosis, osseous metastases). Fractures may be stable or, if there is a risk of damage to the spinal cord, unstable. Diagnosis involves a detailed neurological exam and imaging (x-ray, CT, etc). Stable fractures can be treated conservatively with analgesics and physical therapy. Unstable fractures require surgical intervention such as spinal fusion (spondylodesis), which joins vertebrae through internal fixation. Due to the close proximity to essential anatomical structures (spinal cord, blood vessels), the vertebral fractures and their surgical treatment can cause serious complications.

Epidemiologytoggle arrow icon


Epidemiological data refers to the US, unless otherwise specified.

Etiologytoggle arrow icon


Classificationtoggle arrow icon

Stability of vertebral fractures

A dorsal spine injury (vertebral arches, processes, and their ligaments) is always unstable and has a high probability of spinal cord injury.

Types of vertebral fractures


Clinical featurestoggle arrow icon

  • Local pain on pressure, percussion, and compression
  • Palpable unevenness or disruption of the vertebral process alignment
  • Paravertebral hematoma
  • Weakness or numbness/tingling
  • Neurogenic shock
  • Strong ventral compression with structural kyphosis
  • Depending on complications and any accompanying injuries, further symptoms, potentially as severe as paralysis, are possible.


Diagnosticstoggle arrow icon

Physical exam

  • Detailed neurological exam (cranial nerves, motor and sensory components, coordination, and reflexes)
  • Rectal exam to assess sphincter activation
  • In trauma scenarios, a secondary survey to assess for associated injuries should be done.
  • The need for diagnostic imaging following cervical trauma should be evaluated to avoid unnecessary exposure to radiation, e.g., using the NEXUS criteria, which state that the absence of all of the following indicates a low risk for cervical spine injury and no need for imaging:


Used to assess the stability of the fracture (see “Classification” above), spinal cord lesions

Do not delay urgent interventions (e.g., intubation, fluid resuscitation) in favor of imaging in patients with suspected injury to the spine who are unconscious and/or show signs of hemodynamic or respiratory compromise.


Differential diagnosestoggle arrow icon

Cervical facet dislocation [7][8][9]

Unilateral facet dislocation Bilateral facet dislocation
Clinical features
Diagnostics X-ray
  • Other findings include:
    • Widening of the interspinous distance
    • Hypolordosis at injury level
    • Soft-tissue swelling
    • Potentially, decreased disc height due to retropulsed disc in canal
  • Flexion-extension radiographs to evaluate for instability
  • Shows malalignment or subtle subluxation of the vertebral facet; potentially facet fracture

The differential diagnoses listed here are not exhaustive.

Treatmenttoggle arrow icon


Conservative treatment

Surgical treatment

To minimize the risk of spinal cord lesions causing permanent neurological injury, treatment of unstable fractures should be initiated as soon as possible.


Subtypes and variantstoggle arrow icon

Atlas fracture

Dens fracture

Anderson and D'Alonzo dens fracture classification [12]
Type Characteristics Stability
Type I Oblique fracture through the cranial part of the dens (rare) Stable
Type II Fracture at the base of the dens (most common) Frequently unstable
Type III Dens fracture and affected corpus axis Unstable


Complicationstoggle arrow icon

We list the most important complications. The selection is not exhaustive.

Referencestoggle arrow icon

  1. Parizel PM, Van der zijden T, Gaudino S, et al. Trauma of the spine and spinal cord: imaging strategies. Eur Spine J. 2009; 19 (Suppl 1): p.S8-17.doi: 10.1007/s00586-009-1123-5 . | Open in Read by QxMD
  2. Kaji A, Hockberger RS. Spinal Column Injuries in Adults: Definitions, Mechanisms, and Radiographs. In: Post TW, ed. UpToDate. Waltham, MA: UpToDate. Last updated: July 13, 2016. Accessed: March 9, 2017.
  3. Alexandru D, So W. Evaluation and management of vertebral compression fractures. Perm J. 2012; 16 (4): p.46-51.
  4. Kaji A, Hockberger RS. Evaluation of Thoracic and Lumbar Spinal Column Injury. In: Post TW, ed. UpToDate. Waltham, MA: UpToDate. Last updated: August 30, 2018. Accessed: October 31, 2018.
  5. McCarthy J, Davis A. Diagnosis and management of vertebral compression fractures. Am Fam Physician. 2016; 94 (1): p.44-50.
  6. Gonschorek O, Vordemvenne T, Blattert T, Katscher S, Schnake KJ, Spine Section of the German Society for Orthopaedics and Trauma.. Treatment of Odontoid Fractures: Recommendations of the Spine Section of the German Society for Orthopaedics and Trauma (DGOU).. Global spine journal. 2018; 8 (2 Suppl): p.12S-17S.doi: 10.1177/2192568218768227 . | Open in Read by QxMD
  7. Kandziora F, Scholz M, Pingel A, et al. Treatment of atlas fractures: Recommendations of the Spine Section of the German Society for Orthopaedics and Trauma (DGOU). Global Spine J. 2018; 8 (2): p.5S-11S.doi: 10.1177/2192568217726304 . | Open in Read by QxMD
  8. Bales CP, Chang I, Matheson G, Ouyang D, Dragoo JL. College football player with unstable C1 fracture. Am J Sports Med. 2009; 37 (1): p.195-198.doi: 10.1177/0363546508328594 . | Open in Read by QxMD
  9. $Fracture, odontoid.
  10. Wong CC, McGirt MJ. Vertebral compression fractures: a review of current management and multimodal therapy. J Multidiscip Healthc. 2013; 6: p.205-14.doi: 10.2147/JMDH.S31659 . | Open in Read by QxMD
  11. Saltzherr TP, Fung Kon Jin PH, Beenen LF, Vandertop WP, Goslings JC. Diagnostic imaging of cervical spine injuries following blunt trauma: a review of the literature and practical guideline.. Injury. 2009; 40 (8): p.795-800.doi: 10.1016/j.injury.2009.01.015 . | Open in Read by QxMD
  12. Steinmetz MP, Benzel EC. Benzel's Spine Surgery. Elsevier ; 2016
  13. Zileli M, Osorio-Fonseca E, Konovalov N, et al. Early Management of Cervical Spine Trauma: WFNS Spine Committee Recommendations.. Neurospine. 2020; 17 (4): p.710-722.doi: 10.14245/ns.2040282.141 . | Open in Read by QxMD
  14. Fehlings M. Essentials of Spinal Cord Injury. Thieme Medical Publishers ; 2013
  15. Vieweg U, Grochulla F. Manual of Spine Surgery. Springer Science & Business Media ; 2012
  16. Spinal Fractures. Updated: March 9, 2017. Accessed: March 9, 2017.
  17. Spinal fractures. Updated: April 1, 2016. Accessed: March 9, 2017.
  18. Types of Spinal Fractures. Updated: February 23, 2017. Accessed: March 9, 2017.
  19. Vertebroplasty and Kyphoplasty Comparisons. Updated: February 5, 2014. Accessed: March 9, 2017.

Icon of a lockAccess full content

Sign up and get unlimited access.
 Evidence-based content, created and peer-reviewed by physicians. Read the disclaimer