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September 18, 2025

The Spectrum of Nonadjacent Vertebral Fractures: Misdiagnosis and Management Strategy

Key Points

The prevalence of nonadjacent vertebral fractures in the Iranian population is notably high, showing significant patterns post-trauma.
About 50% of the fractures stemmed from falls greater than 2 meters, with prevalent spinal cord injuries leading to neurological issues.
A classification analysis revealed a notable association between thoracolumbar and cervicothoracic fractures, indicating risks for new injuries.
Identifying risk factors and continuous follow-up for diagnosis of new fractures are crucial for better management strategies.

Abstract

Abstract BACKGROUND: Spinal cord injuries are one of the most common causes of disability and death following trauma. Concurrent spinal cord injuries can lead to neurological disorders and socioeconomic problems. Most previous literature focuses on nonadjacent vertebral fractures (NAVF) after specific treatment. More information about spinal fractures, especially NAVF, is needed to create a comprehensive preventive program in Iran. The current study investigates the prevalence of NAVFs in the Iranian population. METHODS: Patients with multiple and nonadjacent fractures in the vertebral pedicle and lamina diagnosed with magnetic resonance imaging, computed tomography scan, or radiology were included. RESULTS: Forty patients with multiple NAVF were evaluated, including 25% female (10) and 75% male (30). Falls more than 2 m were the most frequent trauma causes (50%), followed by motor vehicle accidents (45%) and pedestrian accidents (5%), respectively. About 35% of patients experienced the concurrence of thoracic and lumbar fractures, followed by cervical and thoracic (20%) and thoracic vertebra fractures alone (15%). There were no significant differences between fracture sites and A. O. classification ( P = 0.23). A significant difference was found between fracture distribution and Franka classification; results have shown that thoracic and lumbar co-occurrence fractures are accompanied by A-class ( P = 0.048). CONCLUSIONS: Our findings indicated that thoracolumbar and cervicothoracic are more prevalent. Our results indicated that lung injuries among extraspinal injuries are common in falling and motor vehicle accidents. Following patients for diagnosis of new vertebra fractures and identifying risk factors is highly recommended.

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