From the Guidelines
The treatment of bone infarcts with compression deformities of the lumbar spine should prioritize nonoperative management, including pain control with NSAIDs and physical therapy, as the initial approach, given the potential risks and limited benefits of surgical interventions like vertebroplasty, as suggested by the strong recommendation against its use in treating symptomatic osteoporotic spinal compression fractures 1.
Initial Management
Initial management focuses on pain control using NSAIDs like ibuprofen (400-800mg three times daily) or naproxen (500mg twice daily), along with muscle relaxants such as cyclobenzaprine (5-10mg three times daily) for associated muscle spasms. For moderate to severe pain, short-term opioid analgesics may be prescribed with caution due to their side effects, including sedation, nausea, and increased fall risk, as noted in the management of vertebral compression fractures 1.
Physical Therapy and Support
Physical therapy should be initiated within 1-2 weeks of diagnosis, focusing on core strengthening exercises, proper body mechanics, and gradual mobility improvement. Bracing with a thoracolumbar orthosis may provide temporary support and pain relief for 6-12 weeks. The goal is to improve mobility and reduce pain while minimizing the risk of further complications.
Surgical Considerations
For patients with significant pain or progressive deformity, kyphoplasty might be considered as an alternative to vertebroplasty, given the moderate recommendation for its use in patients who are neurologically intact 1. However, the decision to proceed with surgical intervention should be made cautiously, considering the patient's overall health, the severity of the deformity, and the potential risks and benefits of the procedure.
Underlying Cause and Follow-Up
The underlying cause of bone infarcts should also be addressed, as they may result from conditions like avascular necrosis, sickle cell disease, or steroid use. Regular follow-up imaging is essential to monitor the progression of the deformities and the response to treatment, allowing for adjustments to the management plan as needed to optimize outcomes in terms of morbidity, mortality, and quality of life.
From the FDA Drug Label
The FDA drug label does not answer the question.
From the Research
Treatment Options for Bone Infarcts with Compression Deformities of Lumbar Spine
- The treatment of vertebral compression fractures (VCFs) typically involves a combination of nonsurgical modalities, including medications, bracing, and physical therapy 2, 3.
- For patients who are refractory to conservative management, vertebral augmentation through either vertebroplasty or kyphoplasty may be considered 4, 2.
- Balloon-assisted kyphoplasty is a procedure with the most evidence of support for reducing pain and improving quality of life in patients with VCFs 5.
- The management of VCFs is multimodal in nature and starts with conservative therapy, with vertebral augmentation considered for patients with inadequate pain relief or significantly impaired quality of life 4, 3.
Evidence for Vertebral Augmentation
- Studies have shown that vertebral augmentation can significantly reduce pain and improve quality of life in patients with VCFs 6, 5.
- Balloon kyphoplasty has been shown to have better pain reduction and height restoration compared to non-surgical management and vertebroplasty 6.
- Vertebral augmentation has been associated with a decrease in morbidity and mortality in patients with VCFs 6.
Considerations for Treatment
- The treatment of VCFs should be individualized, taking into account the patient's symptoms, medical history, and quality of life 2, 3.
- Physicians should be mindful of medication adverse effects in older patients and consider the potential risks and benefits of vertebral augmentation 3.
- Further research is needed to establish a standard of care for patients with VCFs and to develop clearer treatment guidelines 5.