Are further imaging studies needed to assess a compression fracture found on plain films?
It is important to image the entire spine and not just at the site of pain as 20-30% of vertebral fractures will occur at multiple sites. The need for additional imaging depends on the clinical scenario. If there is no neurologic compromise and it is an anterior wedge fracture then the risk for instability is low and further imaging is likely unnecessary. Posterior wedge fractures may be unstable and may be due to secondary causes such as malignancy, osteomalacia, hyperparathyroidism, granulomatous disease, or hematologic disease. If no neurologic compromise is present, then a CT scan is appropriate to evaluate for secondary causes and fracture instability. Urgent MRI is recommended if neurologic abnormalities are present to evaluate for possible fracture fragments in the spinal canal. Emergent surgery may be needed in these cases. A bone scan surveys the entire skeleton looking for fractures. This may be warranted if symptoms are atypical. It is also helpful for finding sacral insuffi
