Treatment of T8 Compression Fracture
Initial Management: Conservative Therapy First
For a T8 compression fracture without neurological deficits, begin with conservative medical management for 2-12 weeks, including analgesics, early mobilization, and optional bracing—both braced and non-braced approaches show equivalent outcomes. 1, 2
Conservative Treatment Protocol (First-Line for 2-12 Weeks)
- Pain control with NSAIDs as first-line agents, with cautious use of narcotics only when necessary due to risks of sedation, falls, and deconditioning 1
- Early mobilization is critical to prevent complications of immobility including decreased bone mineral density, muscle strength loss, and increased mortality 1, 3
- Bracing is optional—neurologically intact patients show equivalent improvement in pain and disability whether treated with or without external bracing 2
- Limited bed rest only—prolonged immobilization leads to physiologic losses from which patients may not recover 1, 3
Key Assessment Points
- Perform thorough neurological examination to identify any deficits that would necessitate surgical consultation 2, 3
- Evaluate fracture stability by assessing for significant vertebral collapse, angulation, or canal compromise 2
- Determine fracture age using MRI with fluid-sensitive sequences (STIR or fat-saturated T2) to identify acute bone marrow edema, which typically resolves in 1-3 months 1
Vertebral Augmentation for Treatment Failures
If pain persists after 3 months of conservative therapy, or if severe pain requires parenteral narcotics or hospitalization, vertebral augmentation (vertebroplasty or kyphoplasty) should be offered. 1
Indications for Vertebral Augmentation
- Failure of conservative therapy defined as pain refractory to oral medications after 3 months 1
- Contraindication to oral analgesics or requirement for parenteral narcotics 1
- Significant pain affecting mobility and quality of life 2
Evidence for Vertebral Augmentation
The most recent high-quality guideline evidence shows vertebral augmentation provides rapid, marked improvement in pain and function compared to continued conservative therapy 1. The hallmark of successful vertebral augmentation is sudden improvement in pain and return of function—not the gradual improvement seen with natural healing over 2-12 weeks 1.
- Vertebroplasty has been shown more effective than continued medical treatment in patients who have failed conservative therapy 1
- Kyphoplasty (balloon-assisted vertebroplasty) shows substantial pain relief and improved mobility, though it costs approximately 2.5 times more than vertebroplasty with no clear superiority demonstrated 1
- Studies comparing kyphoplasty to vertebroplasty show no clinically important difference in pain outcomes 1
Critical Timing Consideration
Denying vertebral augmentation in favor of "more of the same" conservative therapy increases the chance of adverse outcomes associated with low mobility and complications of bed rest and narcotic analgesia 1. The potential complications of conservative therapy are most likely to occur early in the course of immobilization, leading to physiologic losses from which patients may not recover 1.
Surgical Consultation
Reserve surgical intervention for patients with neurological deficits, significant spinal instability, or severe vertebral collapse with canal compromise. 2, 3
Common Pitfalls to Avoid
- Prolonged bed rest causing deconditioning, bone loss, and increased mortality 1, 3
- Overuse of narcotics leading to sedation, falls, and decreased physical conditioning 1, 3
- Missing unstable fractures by failing to perform adequate neurological examination 3
- Delaying vertebral augmentation beyond 3 months in patients with persistent severe pain, exposing them to complications of immobility 1