What is the disposition of an isolated thoracic vertebral endplate fracture?

From the Guidelines

Patients with isolated thoracic vertebral endplate fractures should be managed conservatively as outpatients, focusing on pain control, activity modification, and gradual return to normal activities. The management approach for these patients typically includes pain control with medications such as acetaminophen or NSAIDs, like ibuprofen, for a short period, usually 1-2 weeks, with gradual tapering as pain improves 1. Activity modification is crucial, with patients advised to avoid heavy lifting, excessive bending or twisting, and high-impact activities for 6-8 weeks, while encouraging gentle mobility over strict bed rest 1. A thoracolumbosacral orthosis (TLSO) brace may be prescribed for comfort and stability during the initial healing phase, typically worn for 6-8 weeks when upright. Follow-up imaging with plain radiographs is recommended at 6-8 weeks to assess healing, and physical therapy can begin after 2-4 weeks to improve core strength and posture. Some key points to consider in the management of these fractures include:

• The importance of early mobilization to prevent complications such as deep venous thrombosis and pneumonia 1
• The need for thorough medical management, including appropriate osteoporosis screening and follow-up treatment, especially in postmenopausal women who are at higher risk for developing osteoporotic fractures 1
• The use of the Spinal Instability Neoplastic Score (SINS) to evaluate spinal stability in cases where there is suspicion of underlying malignant or metastatic disease 1 It is essential for patients to be instructed to seek immediate medical attention if they develop new neurological symptoms or worsening pain, as these could indicate fracture progression or spinal cord involvement. Overall, the goal of management is to improve quality of life, increase the expectancy of an independent and productive life, and prevent superimposed medical complications, as suggested by research on the management of painful vertebral compression fractures 1.

From the Research

Disposition of Isolated Thoracic Vertebral Endplate Fracture

The disposition of an isolated thoracic vertebral endplate fracture can vary depending on the severity of the fracture and the presence of any neurological deficits.

• The treatment options for vertebral compression fractures, including isolated thoracic vertebral endplate fractures, typically involve conservative management with analgesic medication, medication for osteoporosis, physical therapy, and bracing 2, 3.
• In some cases, vertebral augmentation through vertebroplasty or kyphoplasty may be considered for patients who are refractory to conservative management 2, 4, 5, 3.
• The decision to operate on a thoracolumbar compression fracture, including an isolated thoracic vertebral endplate fracture, depends on the degree of bony compromise, neurological involvement, and the integrity of the posterior ligamentous complex 4.
• Studies have shown that isolated compression fractures in the absence of neurologic deficit or severe cord compression due to retropulsed bone are self-limiting and may not require surgical intervention 6.
• The treatment of osteoporotic fractures of the thoracolumbar spine, including isolated thoracic vertebral endplate fractures, is an area of ongoing research, with newer procedures such as balloon-assisted kyphoplasty showing promise in reducing pain and improving quality of life 5.