From the Guidelines
The optimal management for an osteoporotic burst fracture in the lumbar spine is Percutaneous Vertebral Augmentation (VA), as it has been shown to provide better pain relief and improved functional outcomes compared to conservative therapy 1.
Key Considerations
- Medical Management is the initial treatment for painful VCFs, including medications such as nonsteroidal anti-inflammatory drugs and narcotics, as well as immobilization with bed rest and bracing 1.
- VA is a treatment option for osteoporotic VCFs, with evidence showing immediate and considerable improvement in pain and patient mobility, and is considered for patients who have not received sufficient pain relief by 3 months with conservative treatment 1.
- Timing of VA is debated, but studies suggest that patients who have not received sufficient pain relief by 3 months with conservative treatment may be candidates for VA, and that the age of the fracture does not independently affect the outcomes of VA 1.
- Comparison of VA techniques shows that VP and BK are equally effective in reducing pain and disability, but BK may provide superior functional recovery compared to VP 1.
Treatment Approach
- For patients with osteoporotic compression fractures, medical management is usually appropriate for the first 3 months 1.
- For patients with spinal deformity, worsening symptoms, or pulmonary dysfunction, percutaneous VA is usually appropriate 1.
- For patients with painful osteoporotic compression fracture and contraindication to VA or surgery, medical management is usually appropriate 1.
From the Research
Optimal Management for Osteoporotic Burst Fracture in the Lumbar Spine
The optimal management for an osteoporotic burst fracture in the lumbar spine is a topic of ongoing debate. Several studies have investigated the efficacy of different treatment options, including percutaneous vertebroplasty, posterior decompression and fusion, open kyphoplasty, and bracing.
Treatment Options
- Percutaneous Vertebroplasty: A study published in 2009 2 found that percutaneous vertebroplasty can be a safe and effective treatment for osteoporotic burst fractures without neurological deficit. The study reported significant improvements in kyphosis angle, wedge angle, and height restoration of the fractured vertebral body.
- Posterior Decompression and Fusion: A case report published in 2020 3 described the surgical treatment of complete fifth lumbar osteoporotic vertebral burst fracture using posterior decompression and fusion. The study reported improved spinal alignment and Japanese Orthopaedic Association (JOA) scores, although the spinal alignment parameters worsened at the final follow-up due to clinical fractures at the adjacent vertebral body and proximal junctional kyphosis.
- Open Kyphoplasty: A study published in 2009 4 investigated the treatment of severe thoracolumbar osteoporotic burst fractures using open kyphoplasty and short-segment fixation. The study reported significant improvements in local kyphosis and vertebral body height restoration, as well as complete neurological recovery in 10 out of 12 patients.
- Bracing: A systematic review published in 2020 5 found limited evidence to support the use of bracing for osteoporotic vertebral fractures. The review reported that bracing may be safe, but there is no compelling evidence to suggest that a rigid brace is superior to a soft brace or no brace.
Complications and Risks
- Cement Leakage: A study published in 2024 6 reported cement leakage in 50 out of 119 patients who underwent unilateral percutaneous kyphoplasty for osteoporotic vertebral burst fracture.
- Vertebral Refracture: The same study reported vertebral refracture in 16 out of 119 patients.
- Neurological Symptoms: None of the patients in the study developed neurological symptoms during the follow-up period.
Efficacy of Treatment Options
- Percutaneous Kyphoplasty: A study published in 2024 6 found that percutaneous kyphoplasty can improve symptoms and reduce posterior wall protrusions in patients with osteoporotic vertebral burst fracture without neurological deficits.
- Kyphoplasty vs. Bracing: A systematic review published in 2020 5 reported that kyphoplasty may be of benefit for select patients, although the evidence is limited.