What are the implications of a T12 (twelfth thoracic vertebra) wedge compression fracture?

From the Guidelines

A vertebral T12 wedge compression fracture should be treated with conservative management, including medical management with or without methods of immobility, as the initial treatment, with consideration of percutaneous vertebral augmentation (VA) for patients who do not respond to conservative treatment or have significant deformity or neurological symptoms. The natural history of most healing vertebral compression fractures (VCFs) is that of gradual improvement in pain over 2 to 12 weeks, with variable return of function 1. Conservative management includes medical management with or without methods of immobility and is the initial treatment of painful VCFs 1.

Some key points to consider in the treatment of vertebral T12 wedge compression fracture include:

• Pain management with acetaminophen (500-1000mg every 6 hours) or NSAIDs like ibuprofen (400-800mg every 6-8 hours) for mild to moderate pain, and short-term opioids for severe pain
• Limited bed rest (1-2 days) followed by gradual activity increase with a back brace for support
• Physical therapy focusing on core strengthening and proper body mechanics once pain allows
• Consideration of VA, such as vertebroplasty or kyphoplasty, for severe cases with neurological symptoms or significant deformity
• Calcium (1000-1200mg daily) and vitamin D (800-1000 IU daily) supplements to help bone healing, and addressing underlying osteoporosis to prevent future fractures
• Regular follow-up imaging to monitor healing progress and ensure the fracture is stable

It is also important to note that vertebral fracture assessment is of value in identifying the presence of vertebral fractures and assessing the risk of future fractures, and that individuals who have sustained a fracture require further clinical evaluation for an underlying cause and to exclude the possibility of a pathologic fracture due to malignancy or infection or other disease state 1. Additionally, the presence of a contributing factor for the underlying osteoporosis or an underlying metabolic bone disease requires evaluation and treatment 1.

In terms of the timing of VA, the VERTOS II trial suggested that patients who had not received sufficient pain relief by 3 months with conservative treatment may be candidates for VA 1. However, other studies have found VA to be superior to placebo intervention for pain reduction in patients with acute osteoporotic VCF of <6 weeks’ duration, and that the age of the fracture does not independently affect the outcomes of VA 1.

Overall, the treatment of vertebral T12 wedge compression fracture should prioritize conservative management, with consideration of VA for patients who do not respond to conservative treatment or have significant deformity or neurological symptoms, and should also address underlying osteoporosis and other contributing factors to prevent future fractures.

From the Research

Vertebral T12 Wedge Compression Fracture

• A vertebral T12 wedge compression fracture is a type of fracture that occurs in the thoracic spine, specifically at the T12 vertebra 2, 3.
• Vertebral compression fractures are the most common complication of osteoporosis, with 700,000 cases reported every year in the United States 2, 3.
• The diagnosis of a vertebral compression fracture is typically confirmed using plain radiographs, while computed tomography and magnetic resonance imaging may be required to evaluate for a malignant cause or if there are neurological deficits on examination 2.

Symptoms and Treatment

• Patients with a vertebral T12 wedge compression fracture may present with abrupt-onset low back pain with or without a history of trauma, although more than two-thirds are detected incidentally 2, 3.
• Treatment options for vertebral compression fractures include conservative management with medications, bracing, and physical therapy, as well as vertebral augmentation procedures such as kyphoplasty or vertebroplasty 2, 4, 3, 5, 6.
• Vertebral augmentation procedures, such as balloon kyphoplasty, have been shown to provide significant pain reduction and improvement in quality of life compared to non-surgical management 4, 6.

Management Strategies

• The management of vertebral compression fractures is multimodal in nature and starts with conservative therapy consisting of analgesic medication, medication for osteoporosis, physical therapy, and bracing 5.
• Patients who are refractory to conservative management may be candidates for vertebral augmentation through either vertebroplasty or kyphoplasty 5.
• Understanding the risk factors, appropriate clinical evaluation, and management strategies are crucial in the treatment of vertebral compression fractures 6.