Simple Wedge Fractures in the Cervical Spine

Vertebral fracture.
Vertebral compression fracture. BSIP/UIG/Universal Images Group/Getty Images

What is a Simple Wedge Fracture?

A simple wedge fracture is a compression fracture in a spinal vertebra. It can occur in the neck, thoracic region or the lumbar (low back) area. This articles focuses mainly on simple wedge fractures in the neck (i.e., cervical spine) but also provides some general information about causes and treatments at the end.

Related: Risks of Spinal Fracture

What Causes a Simple Neck Wedge Fracture?

A simple wedge fracture in the cervical spine occurs most often after a forceful flexion (forward bending) of the neck.

In this injury, the nuchal ligament, which is located at the back of your neck, is pulled.  While the nuchal ligament itself may fare pretty well (it’s very strong and extensive,) this is not always true for the involved neck bones. The front part of the vertebral bodies in the neck tend to bear the brunt of the impact, which in turn may forcefully compress them. The result is a simple wedge fracture at the front of the bone, but no real damage to speak of in back. 

Simple Wedge Fractures - Stable or Unstable?

Simple wedge fractures are often categorized as flexion injuries to the neck. This is because the neck moves into hyperflexion during the inciting incident.

Flexion injuries are the most common type of neck injuries. Another type of flexion injury to the neck is clay shoveler's fracture.

Simple wedge fractures are considered "stable" injuries. This means that, along with other criteria, only the front part of spinal column is affected.

(In recent years, researchers and doctors have begun to use the Cervical Spine Injury Severity Score or CSISS to describe and classify lower neck injuries by the degree of stability in the 4 main areas that make up the spinal column. These areas are the front, back and right and left sides, called "pillars.")

Another type of wedge fracture, aptly named "unstable wedge fracture" affects more than one spinal column "pillar" and meets the other CSISS criteria for instability as well. Like simple wedge fractures, unstable wedge fractures are considered flexion injuries.

Simple Wedge Fracture X-Rays

Simple wedge fractures show up on x-ray as having decreased height at the front of the vertebral body, and increased bone density (which is a consequence of the compression.) The front edge of the vertebral body also may look concave for the same reason.  

And of course, your muscles and other soft tissue will likely be swollen and tender (though this does not show up on x-ray.)

Related:  How Much Radiation Exposure Do You Get from an X-Ray?

Wedge Fractures and Osteoporosis 

Whether in the neck, low back or thoracic area, vertebral compression fractures can be the result of trauma, cancer or osteoporosis

Leading to about 700,000 spinal fractures every year, osteoporosis is the most common cause of a simple wedge fracture, according to Babb and Carlson in their study titled “Vertebral compression fractures: treatment and evaluation.” (The study was published in the August 2006 issue of The Journal of the South Dakota State Medical Association.)

Babb and Carlson say that 40% of these 700,000 yearly spinal fractures affect elderly women over the age of 80.

In a study involving Swedish men ages 69 to 81 that was published in the August 2015 issue of The Bone & Joint Journal, Kherad and associates found 15% of the participants had vertebral fracture that was associated with a low bone mineral density and osteoporosis. Those men who had more than 3 fractures had an even stronger association.

Vertebral Wedge Fracture Treatment.

Vertebral compression fractures may be treated conservatively with bed rest, bracing and strength training, and, of course, pain control. When surgery is appropriate, kyphoplasty or percutaneous vertebroplasty are generally given. Both are minimally invasive procedures that introduce medical cement into the area to restore the height and shape of the spinal bone.

Sources:

Babb A1, Carlson WO. Vertebral compression fractures: treatment and evaluation. S D Med. 2006 Aug. http://www.ncbi.nlm.nih.gov/pubmed/16941851

Davenport, M., MD, et. Al. Cervical Spine Fracture. Medscape website. Last Updated Sept 14, 2014. Accessed Aug 22 2015 http://emedicine.medscape.com/article/824380-overview

Kherad, M., MD. The number and characteristics of prevalent vertebral fractures in elderly men are associated with low bone mass and osteoporosis. The Bone & Joint Journal. August 2015 http://www.bjj.boneandjoint.org.uk/content/97-B/8/1106.long

Vaccaro, A., MD., Spine: Core Knowledge in Orthopedics. Mosby/Elsivier. Philadelphia. 2005.

Zehnder SW1, Lenarz CJ, Place HM. Teachability and reliability of a new classification system for lower cervical spinal injuries. Spine. September 2009 http://www.ncbi.nlm.nih.gov/pubmed/19730211

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