Are L5 fractures an indicator of metastasis?

Objective. To determine whether L5 vertebral body fractures are an indicato r of malignancy. Design and patients. A retrospective study of L5 vertebral body fractures w as carried out using plain radiographs. CT, and/or MRI. Over a 5-year perio d, 51 patients with L5 vertebral body fractures were seen at our institutio n. Since L1 vertebral body fractures are common, 51 age- and gender-matched (20 men, 31 women: mean age 60 years) patients with L1 fractures were util ized as the control group. The frequency of neoplastic infiltration of the vertebrae was compared between these two populations to determine whether p athologic fracture was more frequent at L5. Results. Twelve (24%) of the L5 fractures were pathologic compared with fou r (8%) of the L1 fractures (chi-square test, P<0.05). Neoplasm types includ ed multiple myeloma (n=4), prostate (n=3), breast (n=2), lung (n=2), melano ma (n=2,), bladder, colon, and leukemia teach n=1). Conclusion. Although most L5 Fractures are not pathologic, there is an incr eased incidence of pathologic fractures in this location compared with L1. Therefore, a fracture of L5 should raise the suspicion of metastasis.