From the Guidelines
The management of a T12 compression fracture should initially focus on conservative medical management, including pain control and activity modification, with consideration of percutaneous vertebral augmentation (VA) if there is failure of medical management or in the setting of spinal deformity or pulmonary dysfunction, as evidenced by the 2018 study in the Journal of the American College of Radiology 1. The initial treatment approach involves pain management with medications and activity modification to avoid heavy lifting, bending, and twisting.
- Pain control can be achieved with medications such as acetaminophen or NSAIDs, and if needed, short-term opioids.
- Activity should be modified to prevent deconditioning, with bed rest limited to 1-3 days.
- A thoracolumbosacral orthosis (TLSO) brace may be prescribed for 6-12 weeks to provide stability and reduce pain during healing. The use of VA, including techniques such as vertebroplasty or kyphoplasty, has been shown to be effective in reducing pain and improving functional outcomes compared to conservative therapy, especially in patients with osteoporotic VCFs 1.
- VA may be considered if there is failure of medical management or in the setting of spinal deformity or pulmonary dysfunction.
- The 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 1. Overall, the treatment approach depends on fracture severity, patient age, bone quality, and presence of neurological symptoms, with the goal of pain relief, maintaining spinal stability, and preventing progressive deformity.
From the Research
Management and Treatment for T12 Compression Fracture
The management and treatment for a T12 compression fracture can vary depending on the severity of the fracture and the presence of any neurological deficits.
- Pain control is a primary concern, and can be achieved with acetaminophen or nonsteroidal anti-inflammatory drugs for mild pain or opioids and/or calcitonin for moderate to severe pain 2.
- Medications such as bisphosphonates and denosumab are used to treat osteoporosis, which is a common cause of compression fractures 3.
- Vertebral augmentation procedures, such as vertebroplasty and kyphoplasty, are reserved for patients who have not found symptomatic relief through conservative methods and are effective in achieving pain relief 3, 4.
- Kyphoplasty is a means of treatment for painful osteoporotic vertebral body compression fractures, and its efficacy has been proven in several studies 5, 4.
- Open kyphoplasty can be performed safely and effectively in selected vertebral body compression fractures with retropulsed bone associated with neurological deficit 5.
- Teriparatide (TPTD) conservative treatment has been shown to have similar therapeutic effects to percutaneous vertebroplasty (PVP) in terms of treating acute osteoporotic vertebral compression fracture, but at a lower cost 6.
Surgical Interventions
Surgical interventions, such as posterior decompression and fixation or anterior decompression and reconstruction, may be required if neurological deficits are present 3.
- These procedures can help to relieve pressure on the spinal cord and stabilize the spine.
- The choice of surgical procedure will depend on the individual patient's condition and the severity of the fracture.
Non-Surgical Management
Non-surgical management of T12 compression fractures includes: