What is the management of a wedge compression fracture involving the end plate?

From the Guidelines

Management of a wedge compression fracture involving the end plate typically begins with conservative treatment, but Percutaneous Vertebral Augmentation (VA) may be considered for osteoporotic fractures with significant pain or spinal deformity, as it has been shown to provide better pain relief and improved functional outcomes compared to conservative therapy 1. The initial approach to managing a wedge compression fracture involving the end plate includes:

• Conservative treatment with pain control using NSAIDs like ibuprofen (400-800mg three times daily) or naproxen (500mg twice daily), along with acetaminophen (1000mg three to four times daily, not exceeding 4000mg daily) 1
• Short-term muscle relaxants such as cyclobenzaprine (5-10mg three times daily for 1-2 weeks) may help with associated muscle spasms
• Initial rest for 24-48 hours is recommended, followed by gradual return to activities as tolerated
• A thoracolumbosacral orthosis (TLSO) brace may provide support and pain relief for 6-12 weeks
• Physical therapy should begin within 1-2 weeks, focusing on core strengthening and proper body mechanics For osteoporotic fractures, bisphosphonates like alendronate (70mg weekly) or zoledronic acid (5mg IV annually) may be prescribed 1. In cases where conservative management fails or is not suitable, Percutaneous Vertebral Augmentation (VA) is a viable option, as it has been shown to provide immediate and considerable improvement in pain and patient mobility, and may be considered for patients with significant pain or spinal deformity 1. Surgical intervention, including vertebroplasty, kyphoplasty, or spinal fusion, is typically reserved for cases with neurological deficits, significant instability, or intractable pain 1.

From the Research

Management of Wedge Compression Fracture Involving the End Plate

• The management of wedge compression fractures involving the end plate typically involves a combination of conservative and surgical treatments 2, 3, 4, 5, 6.
• Conservative treatment options include:
  • Pain control using medications such as acetaminophen, nonsteroidal anti-inflammatory drugs, opioids, and calcitonin 3, 6
  • Bracing and physical therapy to improve mobility and reduce pain 3, 4
  • Medication management, including bisphosphonates and denosumab, to treat underlying osteoporosis 4, 6
• Surgical treatment options include:
  • Vertebral augmentation, such as vertebroplasty and kyphoplasty, to stabilize the fracture and reduce pain 2, 3, 4, 5, 6
  • Anterior or posterior decompression and reconstruction to treat neurological deficits or instability 4, 6
• The choice of treatment depends on the severity of the fracture, the patient's overall health, and the presence of any neurological deficits 2, 4, 6.
• A trial of conservative treatment for 3 weeks is often recommended before considering surgical intervention, especially for patients without risk factors for failure of conservative treatment 2.
• Vertebral augmentation, such as kyphoplasty, may be considered for patients who have not responded to conservative treatment and have significant pain and disability 2, 5.