Suspected Low/No Trauma Vertebral Fracture
Vertebral Fracture Analysis (VFA) enables vertebral fractures to be picked up at the same time as bone density scanning. It is replacing plain film X-rays for suspected osteoporotic fractures of the thoracic and lumbar spine for the following patients:
For patients > 50yrs- 80years: If suspected osteoporotic thoracic/ lumbar vertebral fracture – request Vertebral Fracture Analysis via ICE → Radiology → Dexa → ? Vertebral fracture
If suspected possible malignancy related fracture- request plain film via ICE (please state if history of previous malignancy)
Patients <50yrs with risk factors for osteoporotic vertebral fractures may still be referred under the above rules and will have VFA done if judged appropriate by the Bone densitometry radiographer. Please specify clearly why the patient is at higher risk of low trauma fracture.
Patients >80years please refer for plain film X rays ( Dexa scan are not needed for this group of patients, if confirmed fracture, just proceed to treat with bisphosphonate).
NB. If there is technical difficulty with the VFA, patients will automatically have a lateral plain film organised at the same appointment.
Please follow the adult low back pain pathway for unspecified lumbar back pain, including urgent management guidelines.
Red Flags/High Complexity Causes:
The Cauda Equina and Conus Medullaris Syndrome Pathway Remains Unchanged
For Impending/Established Cauda Equina/Conus Medullaris Syndrome
Refer to Emergency Department if structural cause suspected
Discuss with Acute GP Service if metastatic cause suspected
The following presentations also require emergency referral to ED:
-
Spinal pathology with significant/rapidly worsening motor/sensory/sphincter disturbance
-
Severe acute low back pain straight after significant trauma – consider unstable vertebral fracture as cause
Contributors
Dr B Wesson, GP & Kernow RMS Guideline lead Rheumatology
Penny Lewis, Bone Densitometry/Osteoporosis Lead radiographer, RCHT
Dr Tomas Bean, Consultant Radiologist, RCHT