With the aging of the population and the emphasis on quality of life, osteoporosis is increasingly becoming a social problem that plagues the elderly. Osteoporotic fracture is a serious consequence of osteoporosis. Due to the reduced bone mass, decreased bone strength and increased bone fragility, fragility fractures can be caused by minor injuries during daily activities, and osteoporosis vertebra compressed fracture (OVCF) is its most common fracture. Osteoporosis vertebra fractures are commonly seen in postmenopausal women, and the occurrence of OVCF increases significantly with age. According to statistics, the prevalence is about 26% in women over 50 years of age, while the prevalence is as high as 40% in women over 80 years of age. Fractures occur mainly in the thoracic and lumbar migrations, with the thoracic 12 and lumbar 1 segments being the most common, and then in the adjacent vertebrae of the above-mentioned vertebrae. Because spinal fractures are confined to the vertebral body and do not affect the vertebral arch, they rarely result in spinal cord injury. History: A history of trauma is often an important causative factor. A fall or even minor trauma can result in a compression fracture of one or more vertebrae, but some patients with fractures may also have no clear history of trauma, such as a chronic cough. Clinical manifestations: Common clinical manifestations are thoracic back/lumbar pain, decreased height, and kyphosis. Persistent low back and thoracic back pain may be associated with pain in the thoracic ribs. Pain may decrease or disappear at rest and worsen with position changes. OVCF should be considered in the following two situations: 1. Low back pain occurs gradually and worsens over several days, although there is not necessarily a clear history of trauma; 2. Low back pain occurs after a minor trauma such as a fall. Reduced height also suggests the possibility of OVCF, but is not a characteristic presentation. Kyphosis is also a manifestation of OVCF, which can be clearly shown by taking x-rays. Compression fractures of the thoracic spine may present with intercostal neuralgia or epigastric pain. Physical examination: The movement of the thoracolumbar region is limited, and there may be obvious pressure pain and percussion pain of the spinous process of the thoracic and lumbar segments in the acute stage, and there are usually no signs of nerve injury. In rare cases, if the compression or kyphosis is severe and the corresponding segment of the spinal cord or spinal nerve is compressed, abnormal signs such as sensation, movement and reflexes of the lower limbs may appear. The radiographs only reflect the morphological changes of the vertebral body and cannot distinguish old fractures from fresh ones. Lateral radiographs of lumbar compression fractures 2. CT scan: Can be used to determine whether there is a rupture at the posterior edge of the vertebral body. The vertebral body is wedge-shaped or biconcave-like change, its height reduction is obvious in the middle of the vertebral body, the fracture line is often visible, there may be fracture fragment displacement protruding into the vertebral canal, or it may show the posterior cortical arc protrusion of the vertebral body. In addition, reduced bone cancellous density due to osteoporosis is seen. Vertebral compression fracture CT sagittal 3. Magnetic resonance imaging (MRI): It can be used to determine whether OVCF is in the acute stage. The deformation of the vertebral body is wedge-shaped, biconcave or flattened, and the posterior superior edge of the vertebral body is posteriorly curved and protrudes into the spinal canal to compress the dura mater, which is a more characteristic manifestation. In addition, for acute OVCF, the signal is characterized by a band of T1WI low signal and T2WI high signal shadow at the edge or central part of the vertebral body, which is due to the bone marrow edema produced by the vertebral fracture in the acute phase. Chronic OVCF often shows mixed high signal in the vertebral body in T1WI. Lumbar 1 vertebral MRI T1WI low signal Lumbar 1 vertebral MRI T2WI high signal 4, bone scan (SPECT/ECT): suitable for patients who cannot perform MRI examination, such as the presence of metal foreign bodies, claustrophobia, etc., to help determine the vertebral body responsible for pain. ECT shows thoracic vertebral nucleus concentration 5, bone densitometry: often use dual-energy X-ray bone densitometry (DXA), WHO’s diagnostic criteria are: bone density T ≤ -2.5SD for osteoporosis, -2.5SD. Laboratory tests: routine preoperative tests, blood calcium and phosphorus, 25(OH)VitD, calcitonin, parathyroid hormone if necessary, bone transformation biochemical markers can be detected if available: Bone formation indicators – type pro-collagen N-terminal peptide (PINP) and bone resorption indicators – serum type I pro-cross-linked C-terminal peptide (S-CTX). Clinical typing: Vertebral compression in the form of wedge fractures, biconcave fractures, and vertical compression fractures, Genant imaging typing is: 1. mild compression fractures with 20%-25% compression at the original vertebral height; 2. moderate compression fractures with 25%-40% compression at the original vertebral height; 3. severe compression fractures with >40% compression at the original vertebral height. Diagnosis and differential diagnosis: The diagnosis is generally made on the basis of the history, clinical manifestations and imaging examinations. It is necessary to exclude other causes of vertebral fracture or destruction, such as vertebral hemangioma, metastases, multiple myeloma, spinal tuberculosis, etc. It is generally not difficult to differentiate through history, clinical manifestations, laboratory tests and imaging examinations, and if necessary, pathological biopsy is feasible to clarify the diagnosis.