What is the treatment for a wedge compression fracture?

From the Guidelines

Treatment for a wedge compression fracture typically involves a multidisciplinary approach, including pain management, rest, and gradual return to activity, with consideration of minimally invasive procedures like vertebroplasty or kyphoplasty for severe cases. The management of vertebral compression fractures, including wedge compression fractures, has been outlined in guidelines such as those from the American College of Radiology 1, which suggest that the traditional first-line treatment is nonoperative or conservative management. This approach may include the use of nonsteroidal anti-inflammatory drugs and narcotics for pain management, as well as immobilization with bed rest and bracing 1. However, it's crucial to avoid prolonged bed rest due to the risk of muscle weakness and bone loss.

For patients with severe and worsening pain, especially in the context of pathologic fractures, a more aggressive approach may be necessary, including interventional radiology, surgery, and radiation oncology consultation 1. In such cases, percutaneous thermal ablation or percutaneous vertebral augmentation (VA) may be considered. The use of VA has been found to be superior to placebo for pain reduction in patients with acute osteoporotic vertebral compression fractures of less than 6 weeks' duration 1.

Prevention of future fractures is also a critical component of long-term management, which can include calcium and vitamin D supplementation, along with bone density medications if osteoporosis is present. While guidelines from 2011 suggested against the use of vertebroplasty and recommended the use of calcitonin for 4 weeks following fracture onset 1, more recent evidence supports a personalized approach based on the severity of the fracture, patient's condition, and response to initial treatment.

Key aspects of treatment include:

• Pain management with over-the-counter or prescription medications
• Rest and gradual return to activity to avoid muscle weakness and bone loss
• Use of a back brace for support
• Physical therapy for core strengthening and proper body mechanics
• Consideration of minimally invasive procedures for severe or refractory cases
• Prevention of future fractures through supplementation and bone density management.

From the Research

Treatment Options for Wedge Compression Fracture

• Traditional treatment modalities for vertebral compression fractures (VCFs) include bed rest, pain medications, muscle relaxants, back braces, and physical therapy 2.
• Conservative therapy consists of analgesic medication, medication for osteoporosis, physical therapy, and bracing 3.
• Initial treatment includes bed rest, pain management with local and systemic analgesia, bracing to improve comfort, and patient reassurance 4.
• Long-term management includes spinal stretching exercises and continuing ordinary activities within limits permitted by pain 4.

Surgical Interventions

• Core decompression of the vertebral body has been explored as a potential treatment for painful VCFs, but a study found no significant improvement in pain and disability compared to conventional conservative treatment 2.
• Vertebroplasty and kyphoplasty are minimally invasive procedures that can help decrease pain and improve function in fractured vertebrae 3, 5.
• Posterior one level stabilization and fusion is a recommendable surgical procedure for thoracolumbar compression fractures Grade II 6.
• Kyphoplasty offers the additional advantage of realigning the spinal column and regaining height of the fractured vertebra, which may help decrease the pulmonary, GI, and early morbidity consequences related to these fractures 5.

Multidisciplinary Approach

• A multidisciplinary approach to treatment is recommended, including engagement of the patient and their family in the treatment plan 4.
• Goals of treatment include procuring bone mass and preventing injury, back support, physical therapy, occupational therapy, psychosocial support, and prevention of falls 4.
• A back school program can be an effective addition to conventional concepts using physiotherapy exclusively 4.