Fig. 48.1B On the lateral film (top image), a wedge compression fracture will demonstrate loss of anterior height (arrow). The anterior part of the vertebral body should be the same height as the posterior part. Look at the background density of the bones. If all are osteopenic, as here, the aetiology of the fracture may be osteoporosis. Also look at the density of the vertebra in question and whether any of it has been destroyed to suggest a malignant aetiology.

The pedicles on an AP film (lower image) may be important in distinguishing malignant from benign collapse: the pedicles appear round, at the lateral aspects of each vertebral body (arrow). If a pedicle is lost, this is suggestive of a malignant aetiology involving the posterior elements of the vertebra. Osteoporotic collapse generally involves the vertebral body and not the pedicles.

On the AP film, the vertebral body may demonstrate loss of overall height (arrow 2). This is not demonstrated in Fig. 48.1B (lower image) because the height of the posterior aspect of the vertebral body is preserved. It is generally seen in advanced cases in which there is global loss of height of the vertebra.

An end-stage collapsed vertebra is linear and flat – sometimes called a ‘vertebra plana’.

Wedge compression fractures are often multiple – consider imaging the whole spine.