From the Guidelines
To manage a lumbar vertebral compression fracture for an inpatient, a comprehensive approach addressing pain, mobility, and underlying causes while preventing complications is essential, and this should include pain control, early mobilization, and consideration of surgical consultation for patients with neurological deficits or unstable fractures, as recommended by the American College of Radiology 1.
Key Components of Management
- Pain control using a multimodal approach, including acetaminophen, NSAIDs, and opioids as needed, with careful consideration of the potential side effects of narcotics, such as sedation, nausea, and increased fall risk 1.
- Early mobilization with physical therapy consultation to improve mobility and prevent complications, such as deep vein thrombosis and pneumonia.
- Consideration of bracing with a thoracolumbosacral orthosis (TLSO) for unstable fractures or significant pain with mobilization.
- Regular monitoring of neurological status to detect any spinal cord compression.
- Ordering appropriate imaging, including plain radiographs and possibly MRI or CT, to assess fracture characteristics and stability.
Surgical Consultation
- Surgical consultation is recommended for patients with neurological deficits, significant canal compromise, or unstable fractures, as these conditions may require surgical intervention to prevent further complications and improve outcomes 1.
- Surgical consultation may also be helpful for prescribing and supervising immobilization devices.
Additional Considerations
- For osteoporotic fractures, initiation of calcium and vitamin D supplementation, and consideration of starting an anti-resorptive medication, is crucial to prevent further bone loss and reduce the risk of future fractures.
- For fractures causing persistent severe pain despite conservative measures, referral for vertebroplasty or kyphoplasty, especially within 6 weeks of injury, may be considered as a minimally invasive treatment option to alleviate pain and improve mobility.
Multidisciplinary Approach
- A multidisciplinary approach, including interventional radiology, surgery, and radiation oncology consultation, may be necessary for patients with pathologic fractures, spinal deformity, or pulmonary dysfunction, to ensure comprehensive management and optimal outcomes 1.
From the Research
Management of Lumbar Vertebral Compression Fracture
- The management of lumbar vertebral compression fractures in inpatients typically involves a combination of pharmacological and non-pharmacological interventions 2, 3.
- Pharmacological management may include the use of analgesics, such as opioids, paracetamol, and non-steroidal anti-inflammatory drugs (NSAIDs) to manage pain 2.
- Non-pharmacological management may include bed rest, bracing to improve comfort, and patient reassurance 3.
- In some cases, minimally invasive procedures such as kyphoplasty and percutaneous vertebroplasty may be used to alleviate pain and correct sagittal imbalance of the spine 4, 5, 6.
- Long-term management may include spinal stretching exercises, walking, and treatment of underlying osteoporosis with calcitonin or estrogen in selected patients 3.
Treatment Options
- Kyphoplasty and percutaneous vertebroplasty are two minimally invasive techniques that can be used to treat vertebral compression fractures 4, 5, 6.
- These procedures involve the injection of bone cement into the fractured vertebra to stabilize and strengthen the bone 6.
- Vertebroplasty has been shown to be effective in reducing pain and improving quality of life in patients with vertebral compression fractures 6.
- Balloon kyphoplasty is a variation of kyphoplasty that uses a balloon to expand the fractured vertebra before injecting bone cement 5.
Complications and Risks
- Complications of vertebroplasty and kyphoplasty can include cement leakage, radiculopathy, and pulmonary embolism 6.
- However, these complications are relatively rare, and the benefits of these procedures often outweigh the risks 6.
- Appropriate patient selection and use of guiding systems can help minimize the risk of complications 6.