🔑 Key Learning

  • Suspect spinal fracture in patients with sudden severe back pain, especially in the context of trauma or osteoporosis.
  • Pain is typically central, worse on movement or standing, and relieved by lying flat.
  • Examination may reveal point vertebral tenderness.
  • Investigate with X-ray or MRI depending on mechanism and red flags.

👀 Clinical Features

  • Sudden onset of severe, central back pain
  • Pain is:
    • Worse on standing, walking, or activity
    • Relieved by lying flat
  • May follow:
    • Trauma (e.g. fall, RTA)
    • Minimal trauma in patients with osteoporosis or malignancy
  • May present in elderly women with a history of fragility fractures

🧪 Investigations

  • Spinal X-ray – can detect vertebral compression fractures
  • MRI spine – if neurological signs/symptoms, or if malignancy suspected
  • DEXA scan – if osteoporosis is suspected
  • Bloods – if systemic features or concern for malignancy (e.g. FBC, ESR, calcium, ALP)

💊 Management

  • Analgesia – paracetamol or NSAIDs (if no contraindications)
  • Bisphosphonates and calcium/vitamin D – if underlying osteoporosis
  • Back brace – may be considered in some cases
  • Surgical referral – if spinal instability, neurological deficit, or intractable pain

📝 Exam Clues & Clinchers

  • Sudden back pain after bending over in elderly woman → vertebral compression fracture
  • Severe central back pain, point tenderness, worse on standing → spinal fracture
  • Back pain + history of trauma or long-term steroid use → consider spinal fracture