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. Systemic Radionuclide Therapy This procedure is not useful for this clinical scenario. Variant 8: Benign VCF with worsening pain, deformity, or pulmonary dysfunction. Initial treatment. Most VCFs show a gradual improvement in pain over 2 to 12 weeks, with a variable return of function [103,104]. Bone marrow edema associated with acute fractures on MRI typically resolves within 1 to 3 months [50,51]. Medical Management Only Medical management is complementary to other therapies and should be offered in all clinical scenarios. Conservative management includes medical management with or without methods of immobility and is the initial treatment of painful VCFs [36,107,108]. Patients may not be candidates for percutaneous or surgical intervention because of factors related to performance status, pregnancy, infection, or coagulation disorders, among others. Clinical decision-making must account for the overall risk and benefit to the patient. Percutaneous Vertebral Augmentation VA may be a treatment option [36,107] for osteoporotic VCFs because there is evidence that VA is associated with better pain relief and improved functional outcomes compared to conservative therapy [21,23,32,34]. VA has shown immediate and considerable improvement in pain and patient mobility. This supports consideration of VA to abate the secondary sequelae of VCFs, such as decreased bone mineral density and muscle strength with immobility [138,139], increased risk of deep venous thrombosis [138], and deconditioning of cardiovascular and respiratory muscles [1,139].
Management of Vertebral Compression Fractures PCAs. 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. Systemic Radionuclide Therapy This procedure is not useful for this clinical scenario. Variant 8: Benign VCF with worsening pain, deformity, or pulmonary dysfunction. Initial treatment. Most VCFs show a gradual improvement in pain over 2 to 12 weeks, with a variable return of function [103,104]. Bone marrow edema associated with acute fractures on MRI typically resolves within 1 to 3 months [50,51]. Medical Management Only Medical management is complementary to other therapies and should be offered in all clinical scenarios. Conservative management includes medical management with or without methods of immobility and is the initial treatment of painful VCFs [36,107,108]. Patients may not be candidates for percutaneous or surgical intervention because of factors related to performance status, pregnancy, infection, or coagulation disorders, among others. Clinical decision-making must account for the overall risk and benefit to the patient. Percutaneous Vertebral Augmentation VA may be a treatment option [36,107] for osteoporotic VCFs because there is evidence that VA is associated with better pain relief and improved functional outcomes compared to conservative therapy [21,23,32,34]. VA has shown immediate and considerable improvement in pain and patient mobility. This supports consideration of VA to abate the secondary sequelae of VCFs, such as decreased bone mineral density and muscle strength with immobility [138,139], increased risk of deep venous thrombosis [138], and deconditioning of cardiovascular and respiratory muscles [1,139].