Spinal fractures associated with metabolic and metastatic conditions: principles of diagnosis and management

Spinal fractures without significant trauma are commonly observed in daily practice. There are various descriptive terms, such as pathological fracture, vertebral compression fracture (VCF) and insufficiency fracture. Fundamentally speaking the problem arises from the inability of the bone, due to various causes to support physiological load. It is important to be able to rapidly identify the underlying causes of fractures and thus appropriately treat them. We provide an overview of the two key categories to differentiate between and a scheme to determine likely causes. Background biomechanical principles are discussed and treatment pathways reviewed.