Simple Wedge Fractures in the Cervical Spine

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

Causes

A simple wedge fracture in the cervical spine occurs most often after a forceful flexion, or 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 is very strong — the same is not always true for the neck bones that are impacted. 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. Thus, based on the backward location of the nuchal ligament, little or no damage is generally sustained there.

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.

Whiplash injuries are the most common type of neck injuries, which can be caused by excessive neck motion in both flexion and extension. 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 the 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 four 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 other CSISS criteria for instability as well. Like simple wedge fractures, unstable wedge fractures are considered flexion injuries.

X-Rays

The X-ray of a simple wedge fracture shows decreased height at the front of the vertebral body as well as increased bone density. Increased bone density in the vertebral body is a consequence of the compression that is sustained there. 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, although this does not show up on X-ray.

Osteoporosis

Vertebral compression fractures can be the result of trauma, cancer or osteoporosis. This is true regardless of where they may occur.

Leading to about 700,000 spinal fractures every year, osteoporosis is the most common cause of a simple wedge fracture, according to a 2006 study published The Journal of the South Dakota State Medical Association.

The study authors say that 40% of spinal fracture cases affect elderly women over the age of 80.

But elderly men are affected as well. A 2015 study published in The Bone & Joint Journal evaluated Swedish men ages 69 to 81 and found that 15% of participants had a vertebral fracture that was associated with a low bone mineral density and osteoporosis. Men with more than three fractures had an even stronger association.

Treatment

Vertebral compression fractures may be treated conservatively with bed rest, bracing and strength training, and, of course, pain control. Kyphoplasty or percutaneous vertebroplasty may be recommended to patients with compression fractures who have persistent pain after a few weeks of conservative treatment. Both are minimally invasive procedures that introduce medical cement into the area to minimize painful motion of the fracture.

That said, a 2018 study published in the British Medical Journal found that while percutaneous vertebroplasty, as well as sham treatment, both helped relieve pain from acute vertebral compression fractures for up to a year post-procedure, the surgery was not significantly more effective than the sham procedure.