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ICD-10 Physician Tips, Issue #5
Thomas J. Gilbert, Jr. MD, MPP, CDI Chief Clinical Officer
Natalie Culhane, RCM Coding
Karen Rice, Editing and QA Services
12-15-2015
Vertebral Fractures
Vertebral fractures may be traumatic, stress-related or pathologic.
Traumatic fractures are secondary to excessive forces on normal bone, and
fatigue/stress fractures to excessive chronic repetitive forces on normal bone.
Pathologic fractures are secondary to normal forces on abnormal bone and can be seen
with osteoporosis, following radiation therapy or with neoplasm.
Fragility or insufficiency fractures (pathologic fractures secondary to osteoporosis) are
commonly seen with age-related, post-menopausal or senile osteoporosis, with chronic
steroid use, with malabsorption or following oophorectomy.
In the ICD-10 guidelines and in the medical literature, the phrase collapsed vertebra appears to
be synonymous with vertebral fracture. In ICD-10, anterior wedging of the vertebra is included
under collapse.
Many radiologists will refer to a vertebral deformity. Vertebral fractures commonly result in
deformities: compression fractures result in anterior wedge-shaped deformities or
compression deformities; and burst-type fractures result in burst type deformities or vertebra
plana. The term deformity is noncommittal with respect to the chronicity of the fracture,
however, many radiologists reserve the term for old fractures.
Acute and subacute fractures can be distinguished from old fractures on MRI by the presence of
adjacent marrow edema. Old fractures contain normal or fatty marrow on MRI. Pathologic
fractures secondary to neoplasm show replacement of fatty marrow throughout the vertebral
body often with involvement of the posterior elements of the vertebra, areas of osteolysis or
paraspinous masses. Pathologic fractures secondary to neoplasm are often associated with
metastatic lesions in other segments of the spine or pelvis.
Acute and subacute fractures can be distinguished from old fractures on CT by the presence of
acute fracture lines or cortical deformities. Fracture lines are typically not seen on CT unless
there is a nonunion, in which case the fracture line will be corticated. Pathologic fractures
typically show decreased bony density on CT with or without osteolysis, cortical destruction, or
extrasosseous soft tissue mass.
