From the Guidelines
The management of a T2 compression fracture should prioritize kyphoplasty as the treatment of choice, given its effectiveness in providing immediate pain relief and improving functional status, as demonstrated in the Cancer Patient Fracture Evaluation study 1. The treatment approach for a T2 compression fracture involves a multidisciplinary strategy to alleviate pain, stabilize the spine, and promote healing. Key considerations include:
- Pain management with medications such as acetaminophen or NSAIDs, with short-term opioids as needed
- Use of a thoracolumbosacral orthosis (TLSO) brace for 6-12 weeks to provide spinal stability and reduce pain
- Limited bed rest (1-3 days) to prevent complications like muscle atrophy and deep vein thrombosis
- Early initiation of physical therapy, focusing on core strengthening, proper body mechanics, and gradual return to activities
- Supplementation with calcium and vitamin D to support bone healing However, kyphoplasty has been shown to be effective in treating symptomatic vertebral compression fractures, with advantages including immediate pain relief, avoidance of delays in chemoradiation, and potential antitumor effect of bone cement 1. The Cancer Patient Fracture Evaluation study, an RCT, demonstrated significant improvement in back-specific functional status measured by the Roland-Morris disability questionnaire (RDQ) score at 1 month in patients undergoing kyphoplasty compared to nonsurgical management 1. Given the location of the T2 vertebra in the upper thoracic spine and its proximity to vital structures, kyphoplasty is a recommended treatment option for managing painful vertebral compression fractures, with the goal of improving functional status and reducing pain 1.
From the Research
Management and Treatment Options
The management and treatment of T2 compression fractures involve a range of options, including conservative management, vertebral augmentation, and surgical procedures like kyphoplasty.
- Conservative management typically involves a combination of medications, bracing, and physical therapy, and is often the first line of treatment for stable osteoporotic vertebral compression fractures 2.
- Vertebral augmentation, including procedures like kyphoplasty and percutaneous vertebroplasty, can be used to alleviate pain and correct sagittal imbalance of the spine 3, 4.
- Kyphoplasty, in particular, has been shown to be a safe and effective treatment for fresh vertebral compression fractures, with significant improvements in pain and functional outcome reported in several studies 4, 5.
Treatment Outcomes
Studies have reported positive outcomes for patients undergoing kyphoplasty for T2 compression fractures, including:
- Significant pain relief, with decreases in visual analogue score (VAS) reported in the immediate postoperative period and sustained at follow-up 4.
- Improved functional outcome, with decreases in Oswestry Disability Index (ODI) reported at follow-up 4.
- Low complication rates, with few minor complications reported and no significant adverse effects on final clinical outcome 4, 5.
Current Treatment Strategies
Current treatment strategies for spinal compression fractures include:
- Conservative pain management, with medical management using nonsteroidal anti-inflammatory drugs, calcitonin, teriparatide, and bisphosphonates as first-line therapy 6.
- Vertebral augmentation, with balloon-assisted kyphoplasty being the procedure with the most evidence of support 6.
- Surgical procedures like kyphoplasty, which can be used to treat fresh vertebral compression fractures and improve pain and functional outcome 3, 4, 5.