Treatment of Nondisplaced Anterior Osteophyte Fracture
Conservative management with protected weight-bearing and progressive mobilization is the appropriate treatment for nondisplaced anterior osteophyte fractures, with surgical intervention reserved only for cases causing persistent dysphagia or other severe symptoms despite conservative therapy. 1, 2
Initial Management Approach
Nondisplaced fractures should be managed conservatively with protected weight-bearing and gradual mobilization, as this approach has demonstrated excellent clinical outcomes without the complications associated with surgical intervention 2
Monitor for symptom progression over the initial 3 weeks, as this timeframe is critical for determining treatment success 3
Immediate full weight-bearing as tolerated is appropriate for stable, nondisplaced fractures in the absence of contraindications 4
Conservative Treatment Protocol
Implement restricted weight-bearing initially with progressive mobilization based on pain tolerance and fracture stability 2
No traction is required for nondisplaced fractures 2
Early introduction of physical training and muscle strengthening should begin as symptoms allow 5
Pain management should utilize multimodal analgesia strategies 4
Surgical Indications (When Conservative Treatment Fails)
Surgery is indicated only when anterior osteophytes cause persistent dysphagia, airway compromise, or other severe symptoms that fail to improve with conservative management 1
If surgery becomes necessary, anterior osteophytectomy via left lateral cervicotomy is the procedure of choice 1
Instrumented fusion after osteophyte resection is NOT routinely necessary, as osteophytes do not significantly regrow in the long term in the majority of patients, making prophylactic fusion unnecessary 1
Bone Health Assessment and Secondary Prevention
All patients over 50 years with any fragility fracture require systematic osteoporosis evaluation including DXA scanning of spine and hip 6, 5
Calcium supplementation (1000-1200 mg/day) combined with vitamin D (800 IU/day) should be initiated 6
Pharmacological osteoporosis treatment with oral bisphosphonates (alendronate or risedronate) is first-line therapy for patients at moderate-to-high fracture risk to prevent subsequent fractures 6
For patients with oral bisphosphonate intolerance, alternatives include intravenous zoledronic acid or subcutaneous denosumab 6
Monitoring and Follow-up
Clinical assessment at 1 week, then at 1,3,6, and 12 months to evaluate pain scores and functional outcomes 3
Radiographic follow-up to confirm fracture healing and assess for any displacement 7
Long-term continuation of balance training and fall prevention strategies, particularly in elderly patients 5
Common Pitfalls to Avoid
Do not rush to surgery for nondisplaced fractures – the vast majority heal successfully with conservative management, and surgical complications can exceed those of conservative treatment 1, 2, 8
Avoid prophylactic instrumented fusion after osteophyte resection, as it adds unnecessary morbidity without proven benefit 1
Do not neglect osteoporosis evaluation and treatment, as this represents a critical opportunity to prevent future fractures that significantly impact mortality and quality of life 6