What is the management for a 10% lumbar compression fracture?

Management of 10% Lumbar Compression Fracture

Conservative management is the recommended first-line treatment for a 10% lumbar compression fracture without neurological compromise, including pain control, calcium and vitamin D supplementation, and structured physical therapy. 1

Initial Assessment and Management

1. Pain Management:

   • For mild pain: Acetaminophen or NSAIDs 1
   • For moderate to severe pain: Short-term opioids may be considered 1
   • Calcitonin for 4 weeks in acute cases (within 0-5 days after onset) can provide additional pain relief 1

2. Supplementation:

   • Calcium: 1000-1200 mg/day 1
   • Vitamin D: 800 IU/day 1

3. Medication for Osteoporosis:

   • Bisphosphonates are recommended as first-line therapy for preventing future fractures 1
   • Anabolic therapy may be preferred in cases of acute traumatic vertebral compression fracture in patients with osteopenia 1

Interventional Options

For patients with persistent pain despite 3 weeks of conservative treatment, consider:

1. Percutaneous Dorsal Root Ganglion Block (PDRGB):

   • Provides immediate and prolonged pain relief 2
   • Navigation-assisted CT-guided PDRGB with steroid at the pathological level and adjacent levels has shown 90% good outcomes at 1 week post-procedure 2
   • No adjacent compression fractures were found at 1-year follow-up in patients treated with PDRGB alone 2

2. Vertebral Augmentation:

   • Options include vertebroplasty or balloon kyphoplasty 1
   • Both are equally effective in reducing pain and disability 1
   • Consider for patients with risk factors for failure of conservative treatment:
     • Age >78.5 years
     • Severe osteoporosis (T-score <-2.95)
     • BMI >25.5
     • Collapse rate >28.5% 3

Rehabilitation Protocol

1. Early Phase (0-4 weeks):

   • Postural education and activity modification 4
   • Taping into extension to support proper posture 4
   • Limited physical activity with gradual increase as tolerated

2. Intermediate Phase (4-8 weeks):

   • Structured physical therapy program targeting lumbar stabilization 1
   • Early introduction of physical training and muscle strengthening 1
   • Interferential current therapy may provide additional pain relief 4

3. Long-term Phase (8+ weeks):

   • Progressive rehabilitative exercises 4
   • Long-term continuation of balance training 1
   • Ongoing osteoporosis management 2

Special Considerations

• L2 nerve root block is an option for treating patients with L3 or L4 compression fractures 1
• For lower lumbar compression fractures causing radiculopathy due to foraminal stenosis, vertebroplasty may provide dramatic pain relief 5
• Surgery is typically NOT indicated for stable anterior wedge compression fractures without neurological compromise 1

Clinical Pearls and Pitfalls

• Pearl: About 65% of patients with vertebral compression fractures can be successfully treated with conservative management alone 3
• Pearl: Both conservative treatment and kyphoplasty show similar clinical outcomes at 3,6, and 12 months, though kyphoplasty provides better early pain relief in the first month 3
• Pitfall: Failing to identify risk factors for conservative treatment failure may lead to prolonged pain and disability
• Pitfall: Vertebroplasty can cause side effects such as cement leakage, adjacent segment instability, and residual pain 2
• Pitfall: Delaying appropriate treatment can lead to chronic pain and decreased functional capacity

Monitoring and Follow-up

• Assess pain relief and neurological function regularly
• Monitor for subsequent compression fractures, which can occur in both conservatively treated and surgically treated patients 3
• Continue medication for osteoporosis even after pain resolution 2