Physical therapy is likely to be useful in patients with VCFs and osteoporosis. Home exercise programs have a more limited evidence base, with some small trials demonstrating pain reduction, improved balance, and improved quality of life. Back extensor strengthening can improve strength and bone density and reduce the risk of future VCFs. Exercise is beneficial for all patients with osteoporosis [110,111]. Percutaneous Ablation Spine Percutaneous thermal ablation procedures are reserved for symptomatic spinal metastatic disease [112]. Surgical Consultation Surgical intervention is reserved for patients with neurologic deficits, spinal deformity (eg, junctional kyphosis, retropulsion), or spinal instability. Surgical consultation can assist in prescribing and supervising immobilization devices. Radiation Oncology Consultation There is no role for RT in a patient without a cancer diagnosis and a nonpathologic VCF. If cancer is thought to be the cause of a VCF, a biopsy is needed to confirm a cancer diagnosis. RT is reserved for metastatic spinal disease and typically for those spinal metastases causing pain, neurologic compromise, or those asymptomatic lesions with radiologic features suggesting a risk of neurologic compromise or VCF. Variant 6: Symptomatic osteoporotic VCF with bone marrow edema or intravertebral cleft. Initial treatment. Medical Management Only The traditional first-line treatment of painful VCFs has been nonoperative or conservative management [107,108]. Conservative management includes a short period of bed rest followed by gradual mobilization with external orthoses. Because VCFs are flexion-compression injuries, a hyperextension brace is used. These braces may be beneficial for the first few months until the pain resolves [101]. Although younger patients may tolerate bracing well, elderly patients generally do not because of increased pain with bracing, leading to limited activity with more bed rest.
Management of Vertebral Compression Fractures PCAs. Physical therapy is likely to be useful in patients with VCFs and osteoporosis. Home exercise programs have a more limited evidence base, with some small trials demonstrating pain reduction, improved balance, and improved quality of life. Back extensor strengthening can improve strength and bone density and reduce the risk of future VCFs. Exercise is beneficial for all patients with osteoporosis [110,111]. Percutaneous Ablation Spine Percutaneous thermal ablation procedures are reserved for symptomatic spinal metastatic disease [112]. Surgical Consultation Surgical intervention is reserved for patients with neurologic deficits, spinal deformity (eg, junctional kyphosis, retropulsion), or spinal instability. Surgical consultation can assist in prescribing and supervising immobilization devices. Radiation Oncology Consultation There is no role for RT in a patient without a cancer diagnosis and a nonpathologic VCF. If cancer is thought to be the cause of a VCF, a biopsy is needed to confirm a cancer diagnosis. RT is reserved for metastatic spinal disease and typically for those spinal metastases causing pain, neurologic compromise, or those asymptomatic lesions with radiologic features suggesting a risk of neurologic compromise or VCF. Variant 6: Symptomatic osteoporotic VCF with bone marrow edema or intravertebral cleft. Initial treatment. Medical Management Only The traditional first-line treatment of painful VCFs has been nonoperative or conservative management [107,108]. Conservative management includes a short period of bed rest followed by gradual mobilization with external orthoses. Because VCFs are flexion-compression injuries, a hyperextension brace is used. These braces may be beneficial for the first few months until the pain resolves [101]. Although younger patients may tolerate bracing well, elderly patients generally do not because of increased pain with bracing, leading to limited activity with more bed rest.