From the Guidelines
The primary treatment for a posterior spinous process fracture is typically conservative management, focusing on pain control and gradual mobilization. Here's a specific treatment approach:
- Rest and activity modification: Initially limit activities that exacerbate pain for 1-2 weeks.
- Pain management:
- NSAIDs: Ibuprofen 400-600 mg every 6-8 hours or naproxen 250-500 mg twice daily for 1-2 weeks.
- If needed, short-term opioids like hydrocodone/acetaminophen 5/325 mg, 1-2 tablets every 4-6 hours for severe pain, typically for no more than 3-5 days.
- Ice therapy: Apply ice packs for 15-20 minutes every 2-3 hours for the first 48-72 hours to reduce inflammation.
- Gentle mobilization: Begin with light stretching and range-of-motion exercises after the initial rest period, gradually increasing activity as tolerated.
- Physical therapy: Start 1-2 weeks after injury, focusing on core strengthening and proper body mechanics.
- Bracing: In some cases, a soft brace may be recommended for comfort, but avoid prolonged use to prevent muscle weakness.
- Follow-up: Schedule a follow-up appointment in 2-4 weeks to assess healing progress. This conservative approach is usually sufficient because posterior spinous process fractures are typically stable and do not compromise spinal cord integrity, as supported by the general principles of fracture management 1. The goal is to manage pain while allowing the bone to heal naturally, which usually occurs within 6-8 weeks. Surgery is rarely necessary unless there are complications or associated injuries, and simple immobilization is appropriate when fracture fragments are small, nonarticular, or minimally displaced 1.
From the Research
Treatment for Posterior Spinous Process Fracture
- The treatment for posterior spinous process fracture is not directly addressed in the provided studies, but we can look at the treatment for similar conditions such as transverse process fractures and osteoporotic thoracolumbar fractures.
- For isolated transverse process fractures, conservative management without neurosurgical or orthopedic consultation is appropriate 2, 3.
- The treatment for osteoporotic thoracolumbar fractures includes conservative measures such as short bed rest, analgesics, bracing, and exercises in the acute stages 4.
- For patients who develop severe pain not responding to nonoperative measures and painful nonunion, percutaneous cement augmentation procedures including vertebroplasty or kyphoplasty have been suggested 4.
- Instrumented stabilization is advised for fractures with severe collapse and that lead to neurological deficit and increasing kyphosis 4.
Considerations for Treatment
- It is essential to evaluate the patient's overall condition, including the presence of other spinal injuries or abdominal injuries, when treating a posterior spinous process fracture 2, 3.
- The treatment approach may vary depending on the patient's age, with pediatric patients often benefiting from conservative management and aggressive treatment of comorbidities 3.
- Clinicians must maintain a high index of suspicion for new onset lower back or sacral pain after lumbosacral surgery and order a CT scan to rule out a potential insufficiency fracture 5.