What is the management for an acute compression fracture of the 13th thoracic vertebra (T13) with 15% height loss?

From the Guidelines

Management of an acute T13 compression fracture with 15% height loss should prioritize conservative treatment, focusing on pain control, activity modification, and supportive care, as the risk of morbidity and mortality is lower with this approach 1.

Key Components of Management

• Pain management with acetaminophen (500-1000mg every 6 hours) and NSAIDs like ibuprofen (400-600mg every 6-8 hours) if not contraindicated, as these are effective for pain reduction in patients with acute osteoporotic VCF of <6 weeks’ duration 1
• A short course of opioids may be necessary for 1-2 weeks for more severe pain, but should be used with caution due to associated effects of sedation, nausea, and fall risks 1
• Muscle relaxants such as cyclobenzaprine (5-10mg three times daily) can help with associated muscle spasms
• Activity should be modified but not eliminated, maintaining gentle movement while avoiding activities that exacerbate pain
• A thoracolumbar brace may provide support and pain relief for 6-8 weeks during healing
• Physical therapy should begin within 2-4 weeks, focusing on core strengthening and proper body mechanics

Additional Considerations

• Calcium (1000-1200mg daily) and vitamin D (800-1000 IU daily) supplementation supports bone healing
• If the fracture is related to osteoporosis, bone density testing and appropriate treatment should be initiated
• Surgery is rarely needed for fractures with less than 30% height loss unless there is neurological compromise or significant instability, and other treatment options like vertebroplasty or kyphoplasty may be considered for symptomatic vertebral compression fractures 1

From the Research

Management of Acute Compression Fracture of T13 with 15% Height Loss

• The management of vertebral compression fractures, including those with 15% height loss, typically involves a combination of conservative and surgical modalities 2, 3, 4, 5.
• Conservative management includes medications such as analgesics, calcitonin, and bisphosphonates, as well as bracing and physical therapy 2, 3, 4, 5.
• Surgical options, including vertebroplasty and kyphoplasty, may be considered for patients with inadequate pain relief or significant height loss 2, 3, 4, 5.
• A study comparing vertebral augmentation with conservative management found that surgical treatment was associated with sooner pain relief and lower progression of treated fractures, but longer hospital stay 6.
• The choice of treatment should be individualized based on the patient's specific condition, medical history, and preferences 2, 3, 4, 5.

Treatment Options

• Conservative management:
  • Medications: analgesics, calcitonin, bisphosphonates 2, 3, 4, 5
  • Bracing and physical therapy 2, 3, 4, 5
• Surgical options:
  • Vertebroplasty and kyphoplasty 2, 3, 4, 5
  • Balloon-assisted kyphoplasty 2

Considerations

• The patient's age, medical history, and overall health should be taken into account when selecting a treatment option 2, 3, 4, 5.
• The potential risks and benefits of each treatment option should be carefully considered 2, 3, 4, 5.
• A multidisciplinary approach, including input from orthopedic surgeons, radiologists, and physical medicine and rehabilitation specialists, may be helpful in managing complex cases 2, 3, 4, 5.