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“Twist and Shout” Novel Vertebral Compression

Fracture Physical Exam Finding

Sadiya Farooqui D.O, Fellow Inspira Health Network Vincent Disabella D.O., FAOASM

Rahul V. Shah M.D., FAAOS

Research Podium Presentation

Discussion Points n  Study

n  Purpose n  Relevance n  Methods and Study Design n  Results

n  Significance of Findings n  Conclusions

Purpose

n  To develop decision rules based on physical examination findings that will predict vertebral compression fractures (VCFs) in patients presenting with back pain, thereby assisting physicians in their clinical decision making

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The “Twist Test”

n  A positive "twist test”, will elicit pain in an acute vertebral compression fracture

n  The study suggests that a patient with a positive “twist test” and tenderness to palpation over a specific spinous processes will have imaging positive for a vertebral compression fracture

n  This test is designed to be a cost effective method of determining which patients require further workup

Significance

n  VCFs affect approximately 25% of all postmenopausal women in the USA

n  Men older than 65 years of age are also at risk n  Age group >65 fastest growing segment of U.S.

population n  Annual estimated cost of VCFs in US is

estimated at $746 million

Types of VCFs

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Symptoms and Complications

Risk Factors

Relevance

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Relevance

Study and Design

n  The study was conducted as a case series at a large outpatient Orthopedic facility in New Jersey, with over 55,000 estimated patient visits annually

n  Patients complaining of acute low back pain were evaluated using standard history and physical examination, and in addition were given a “twist test” n  A positive “twist test” was defined as pain elicited by a

patient either in a standing or seated position when rotating the thoracolumbar spine

n  A positive twist test was then evaluated by further imaging

Patient Population

0

10

20

30

40

50

60

70

80

90

100

1 3 5 7 9 11 13 15 17 19

MaleFemale

Patient ID

Age

676869707172737475 Male

Female

Average Age

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“Twist Test” and Imaging

No FractureFracture

Case 15 n  82M s/p fall hx pacemaker placement

Case 15

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Significance of Findings

Conclusion

n  A positive “twist test” in an acute low back pain setting in a patient with risk factors may be significant in diagnosing an acute vertebral compression fracture

n  This test is designed to be a cost effective

method of determining which patients require further workup

References n  Phillips FM. Minimally invasive treatments of osteoporotic vertebral compression

fractures. Spine 2003;28:S45–53. n  Schlaich C, Minne HW, Bruckner T, et al. Reduced pulmonary functionin patients with

spinal osteoporotic fractures. Osteoporos Int1998;8:261–7. n  Leech JA, Dulberg C, Kellie S, et al. Relationship of lung function to severity of

osteoporosis in women. Am Rev Respir Dis 1990;242:68–71. n  Lyles KW, Gold DT, Shipp KM, et al. Association of osteoporotic vertebral

compression fractures with impaired functional status. Am J Med 1993;94:595–601. n  Thomas JS, France CR. The relationship between pain-related fear and lumbar flexion

during natural recovery from low back pain. Eur Spine J 2008;17:97–103. n  Thomas JS, France CR, Sha D, Johnson MR. The influence of pain-related fear on

peak muscle activity and force generation during maximal isometric trunk exertions. Spine 2008;33:E342–8.

n  Trost Z, France CR, Sullivan MJ, Thomas JS. Pain-related fear predicts reduced spinal motion following experimental back injury. Pain 2012;153:1015–21.