Cervical Spine Fractures and Osteoporosis

Abstract

Osteoporosis as a generalized bone disease appears to affect the cervical spine differently from other spinal regions. Failure of the anterior column, i.e., vertebral body osteoporosis fractures, is typically seen in the thoracolumbar junction and the midthoracic region and is virtually unknown above the T4 level [1]. This may be related to biomechanical and histomorphological differences between the various spinal regions. Edmonston et al. [2] have shown for the thoracolumbar region up to the level T1 that vertebral body failure load strongly correlates with bone mineral density (BMD) and much less with vertebral dimensions. Biomechanical compressive tests, however, have shown that cervical spine segments may withstand considerable forces without apparent failure, even in old-aged specimens (P.A. Cripton, unpublished data). It may therefore be possible that force flows in the cervical spine differ from those in other spinal regions, such that the anterior column and thereby the vertebral bodies are less loaded. The different anatomical dimensions and relations between the anterior column and the posterior elements in the cervical spine may be a reflection of these force flows. The principal loading of the cervical spine results from dynamic rather than static processes as in the lumbar spine.