Do vertebral fractures resolve spontaneously?

From the Guidelines

Spinal fractures generally do not resolve on their own and require proper medical treatment. The management depends on the type, location, and severity of the fracture. According to the most recent evidence 1, minor compression fractures may heal with conservative treatment including rest, pain medication (such as acetaminophen, NSAIDs, or prescribed opioids if necessary), bracing (typically worn for 6-12 weeks), and gradual physical therapy. However, more severe fractures, unstable fractures, or those causing neurological symptoms require surgical intervention, which may include vertebroplasty, kyphoplasty, spinal fusion, or the placement of screws, rods, or plates.

The healing process typically takes 6-12 weeks for simple fractures and up to several months for more complex injuries. Proper treatment is essential because untreated spinal fractures can lead to chronic pain, deformity, neurological damage, or disability. As noted in 1, most patients with osteoporotic VCF have spontaneous resolution of pain, even without medication, in over 6 to 8 weeks. However, this does not mean that the fracture has fully resolved, and further treatment may be necessary to prevent complications.

In some cases, vertebral augmentation (VA) may be a treatment option for osteoporotic VCFs, as there is evidence that VA is associated with better pain relief and improved functional outcomes compared to conservative therapy 1. The timing of when VA is appropriate has been debated, but studies have found VA to be superior to placebo intervention for pain reduction in patients with acute osteoporotic VCF of <6 weeks’ duration 1.

Key points to consider in the management of spinal fractures include:

• The type, location, and severity of the fracture
• The presence of neurological symptoms or spinal deformity
• The patient's overall health and medical history
• The potential benefits and risks of different treatment options, including conservative management, VA, and surgical intervention. As noted in 1, approximately 1 in 5 patients with osteoporotic VCFs will develop chronic back pain as a result of the fracture, highlighting the importance of proper treatment and management. Therefore, it is essential to seek professional medical evaluation and treatment for any suspected spinal fracture to ensure proper healing and prevent complications.

From the Research

Spinal Fracture Resolution

• Spinal fractures may not resolve on their own, and the optimal treatment approach is often debated among medical professionals 2, 3.
• Studies suggest that early stabilization of spinal fractures can lead to reduced morbidity, improved neurological outcomes, and shorter hospital stays 2, 3.
• However, the quality of evidence is low, and the safety of early fixation in severely injured patients is still a topic of discussion 2.

Treatment Approaches

• Surgical fixation is a common treatment approach for spinal fractures, and the timing of this procedure can impact patient outcomes 2, 3.
• Early fixation (within 72 hours) may not confer a morbidity benefit and has no impact on length of stay, according to some studies 2.
• Other studies suggest that early fixation (within 24 hours) can reduce major complications by 25%-30% in patients without spinal cord injury 3.

Non-Surgical Management

• Non-steroidal anti-inflammatory drugs (NSAIDs) may be used to manage pain in patients with spinal fractures, but their effect on spinal fusion rates is still unclear 4.
• Short-term use of low-dose NSAIDs around the time of spinal fusion surgery may be reasonable, but more research is needed to fully understand their impact 4.
• Other non-surgical management approaches, such as the use of intravenous acetaminophen, may also be effective in managing perioperative pain in adult elective neurospine surgical patients 5.