Both fluoroscopy- and CT-guided spine biopsies can be performed with high diagnostic accuracy and few complications [102]. Variant 5: Asymptomatic, osteoporotic VCF. Initial treatment. Most patients with VCFs have 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]. 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. Medical Management Only Medical management is complementary to other therapies and should be offered in all clinical scenarios. The natural history of most healing VCFs is that of gradual improvement in pain over 2 to 12 weeks, with a variable return of function [103,104]. Conservative management includes medical management with or without methods of immobility and is the initial treatment of painful VCFs [36,107,108]. Vertebral Compression Fractures Asymptomatic osteoporotic VCFs do not require active management if not associated with focal mechanical pain and if there is no restriction of physical activity due to the fracture. Patients should return for a follow-up evaluation after 2 to 4 weeks of nonsurgical management, and, after a satisfactory result, continued follow-up may be unnecessary. Additional imaging and clinical assessment may be obtained for patients who have recurrence or persistence of symptoms to determine the source of their discomfort. There should be continuous evaluation and treatment for the underlying disorder of osteoporosis to prevent future fractures. Concerning follow-up, most currently available guidelines are restricted to recommendations on pharmacologic treatment for osteoporosis [109].
Management of Vertebral Compression Fractures PCAs. Both fluoroscopy- and CT-guided spine biopsies can be performed with high diagnostic accuracy and few complications [102]. Variant 5: Asymptomatic, osteoporotic VCF. Initial treatment. Most patients with VCFs have 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]. 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. Medical Management Only Medical management is complementary to other therapies and should be offered in all clinical scenarios. The natural history of most healing VCFs is that of gradual improvement in pain over 2 to 12 weeks, with a variable return of function [103,104]. Conservative management includes medical management with or without methods of immobility and is the initial treatment of painful VCFs [36,107,108]. Vertebral Compression Fractures Asymptomatic osteoporotic VCFs do not require active management if not associated with focal mechanical pain and if there is no restriction of physical activity due to the fracture. Patients should return for a follow-up evaluation after 2 to 4 weeks of nonsurgical management, and, after a satisfactory result, continued follow-up may be unnecessary. Additional imaging and clinical assessment may be obtained for patients who have recurrence or persistence of symptoms to determine the source of their discomfort. There should be continuous evaluation and treatment for the underlying disorder of osteoporosis to prevent future fractures. Concerning follow-up, most currently available guidelines are restricted to recommendations on pharmacologic treatment for osteoporosis [109].