What is the treatment and further management for a 36-year-old male with a compression burst fracture of the L3 (lumbar 3) vertebral body, resulting in a loss of height and displaced fracture, after a recent fall from height, in an ambulatory patient?

From the Guidelines

For a 36-year-old male with a compression burst fracture of the L3 vertebral body showing loss of height following a fall from height, I recommend immediate spine consultation while initiating conservative management, as suggested by the most recent guidelines 1. The patient should be placed on bed rest with log-roll precautions and fitted with a thoracolumbosacral orthosis (TLSO) brace for spinal stabilization. Pain management should include scheduled acetaminophen and NSAIDs such as ibuprofen (if not contraindicated), and opioid analgesics like oxycodone as needed for breakthrough pain. Advanced imaging with CT and MRI of the lumbar spine is essential to fully assess the fracture pattern, spinal canal compromise, and potential neural compression, as recommended by the American College of Radiology 1. Some studies suggest the use of calcitonin for 4 weeks following the onset of fracture, but this is based on older guidelines 1 and may not be directly applicable to this patient's situation. Since the patient is ambulatory, suggesting neurological function is preserved, surgical intervention may not be immediately necessary, but this depends on fracture stability assessment by the spine specialist. Physical therapy should be initiated once cleared by the specialist, typically within 6-8 weeks, focusing on core strengthening and proper body mechanics. Long-term management includes gradual return to activities over 3-6 months, bone health assessment, and possible calcium and vitamin D supplementation to support healing. This approach balances the need for spinal stability while preserving function in this young patient with what appears to be a stable burst fracture, prioritizing morbidity, mortality, and quality of life as the primary outcomes. Key considerations in management include:

• Immediate spine consultation
• Conservative management with bed rest and bracing
• Advanced imaging for fracture assessment
• Pain management with acetaminophen, NSAIDs, and opioids as needed
• Potential use of calcitonin based on individual patient factors
• Gradual return to activities and long-term bone health management.

From the Research

Treatment and Management of Lumbar Compression Burst Fracture

The patient, a 36-year-old male, has been diagnosed with a compression burst fracture of the L3 vertebral body, with a loss of height and displacement of the fracture. The patient is ambulatory and has a recent history of a fall from height.

• The treatment and management of lumbar burst fractures typically involve surgical intervention, as seen in the case report of a young man with a rotational burst fracture of the third lumbar vertebra, who was treated with posterior surgery consisting of reduction, decompression, fusion, and transpedicular instrumentation 2.
• The surgical approach may include posterior decompression, fusion, and transpedicular fixation, as well as anterior fusion using pelvic autografts 2.
• The management of burst fractures must include reduction, decompression, restoration, and fusion of anterior and posterior elements, using autologous pelvic spongious autografts, and anterior or posterior instrumentation 2.
• The treatment algorithm for burst fractures may be developed with the aid of principles such as coronal and sagittal alignment of the spine, patency of the neural canal, the two-column concept of spinal stability, and bony vertebral body reconstitution 3.

Evaluation of Stability

• The evaluation of stability in burst fractures is crucial, and radiographic signs of instability include widening of the interspinous and interlaminar distance, translation of more than 2mm, kyphosis of more than 20 degrees, dislocation, height loss of more than 50%, and articular process fractures 4.
• However, fractures may be unstable in the absence of these signs, and unrecognized supraspinous ligament disruption may contribute to this instability, which can be best evaluated by MR examination 4.

Diagnosis and Treatment of Vertebral Compression Fractures

• Vertebral compression fractures are a common ailment among adults, especially those with low bone mass or osteoporosis, and can be diagnosed using plain radiographs, computed tomography, and magnetic resonance imaging 5, 6.
• The treatment of vertebral compression fractures may involve a combination of nonsurgical modalities, including medications, bracing, and physical therapy, as well as surgical interventions such as kyphoplasty or vertebroplasty 6.