What are the implications of a lumbar vertebral body fracture?

From the Guidelines

Lumbar vertebral body fractures should be managed with a focus on pain relief, stabilization, and prevention of further complications, with conservative treatment recommended for stable compression fractures and surgical intervention for unstable or complicated cases. The management of lumbar vertebral body fractures depends on the severity and type of fracture, as well as the presence of any neurological deficits or underlying conditions such as osteoporosis. For stable compression fractures without neurological deficits, conservative treatment is recommended, including:

• Pain management with acetaminophen (500-1000mg every 6 hours) or NSAIDs like ibuprofen (400-600mg every 6-8 hours) for 1-2 weeks, followed by gradual weaning 1
• Muscle relaxants such as cyclobenzaprine (5-10mg three times daily) may help with associated muscle spasms for short-term use (7-10 days)
• Initial rest for 1-3 days is advised, followed by gradual mobilization with a back brace for support
• Physical therapy should begin within 1-2 weeks to strengthen core muscles and improve posture

For unstable fractures, burst fractures, or those with neurological compromise, surgical intervention may be necessary, including vertebroplasty, kyphoplasty, or spinal fusion 1. Osteoporotic patients should also receive bone density assessment and appropriate treatment to prevent future fractures, including calcium (1000-1200mg daily), vitamin D (800-1000 IU daily), and possibly bisphosphonates or other bone-strengthening medications. The goal of treatment is to alleviate pain, prevent further complications, and improve quality of life, with a focus on individualized care based on the specific needs and circumstances of each patient.

Some key points to consider in the management of lumbar vertebral body fractures include:

• The importance of prompt medical attention and appropriate management to prevent further complications and improve outcomes
• The need for individualized care based on the specific needs and circumstances of each patient
• The role of conservative treatment, including pain management and physical therapy, in the management of stable compression fractures
• The potential benefits of surgical intervention, including vertebroplasty, kyphoplasty, or spinal fusion, for unstable or complicated cases
• The importance of addressing underlying conditions, such as osteoporosis, to prevent future fractures and improve overall health and well-being.

From the Research

Lumbar Vertebral Body Fracture Overview

• Lumbar vertebral body fractures are debilitating injuries that can cause significant patient deformity, disability, pain, and potentially neurological deficit 2.
• The annual incidence rate of total lumbar fractures in the U.S. increased from 14.6 to 22.5 per 100,000 people from 2010-2018, with floors, stairs/steps, and ladders being the most common etiologies of lumbar fractures 2.

Management and Treatment

• Painful vertebral body compression fractures are prevalent in elderly patients, with two-thirds of patients experiencing spontaneous resolution of pain in 4 to 6 weeks, and initial management is nonoperative with pain management and bracing 3.
• Patients with persistent back pain and bone marrow edema on magnetic resonance imaging may benefit from injection of cement into the fractured vertebral body with either vertebroplasty or kyphoplasty 3.
• Surgical management may be necessary for patients with severe pain refractory to nonoperative management, with potential risk factors for vertebral body fractures including obesity, osteopenia, unrecognized intraoperative endplate breach, graft subsidence, and oversized graft placement 4.

Complications and Outcomes

• Vertebral body fractures can occur as a complication of lateral lumbar interbody fusion (LLIF), with a reported incidence of 0.6% in one study 4.
• Proximal vertebral body fracture can occur after multi-level fusion surgeries, particularly in osteoporotic patients, and may be related to junctional kyphosis and fusion failure 5.
• Patients who undergo non-operative management for burst fractures of the first lumbar vertebra may report a good functional outcome, while those who require surgical stabilization may report a poorer functional outcome 6.