Compression and Wedge Fractures: Treatment and Recovery

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The majority of mild to moderate compression fractures are treated with immobilization in a brace or corset for a period of six to twelve weeks. The duration of treatment is based on symptoms and x-ray. As pain subsides and x-rays show no change in the position of the spine and healing of the fracture, the brace may be discontinued.

The purpose of the brace is two-fold. Bracing helps to reduce acute pain by immobilizing the fracture. It also helps to reduce the eventual loss in height and in angulation from the fracture. Compression fractures treated in a brace tend to have less deformity than those treated without a brace. Occasionally, bracing beyond twelve weeks is indicated in those patients with severe osteoporosis.
Woman being fitted for a cervical collarCervical spine compression fractures may be immobilized using a rigid collar and/or a soft collar. Neck Compression Fractures
Cervical spine compression fractures may be immobilized using a rigid collar and/or a soft collar. Medications, such as analgesics and/or muscle relaxants may help lessen the pain of a compression fracture.

Balloon Kyphoplasty is a newer minimally invasive treatment performed to stabilize vertebral compression fractures and reduce pain. The procedure is performed under local or general anesthesia. After a small pathway is created into the fractured bone, a small orthopaedic balloon is guided into the vertebra. The balloon is gently inflated to create a cavity within the vertebral body. The cavity is filled with medical cement that sets to stabilize the fracture and reduce pain..

Percutaneous vertebroplasty is a surgical procedure performed under anesthesia that may be used to treat compression fractures. During this procedure, a catheter is advanced into the compressed vertebra. Through the catheter, bone cement is injected into the fractured vertebra. The bone cement hardens to stabilize the vertebral body. This procedure may be indicated in cases of severe osteoporosis, severe pain, or when a vertebral fracture fails to heal following bracing treatment.

Spinal surgery is rarely indicated for patients with compression fracture. Indications would include severe fracture with neurologic injury, severe angulation, failure to heal with initial bracing, increased angulation despite bracing or late increasing neuologic deficit.

Stabilization and Fusion
In most cases, surgery consists of stabilization of the affected portion of the spine. This can be performed with rods and hooks placed from the posterior (back) of the spine. Occasionally the procedure may be performed anteriorly (from the front) to remove the broken vertebra and replace it with a plate, screws or cage. Either of these approaches involves a spinal fusion of the broken vertebra and its adjacent segments. Because of osteoporosis, these procedures are difficult and may require three to six months for recovery.

Specific details of indication and type of surgery should be obtained from your personal spine surgeon.

Most patients can expect to make a full recovery from their compression fracture. Typically, braces are worn for six to twelve weeks followed by three to six weeks of physical therapy and exercise. This is to help regain strength of the trunk muscles and to increase endurance of the trunk musculature. Overall strength, aerobic capacity and flexibility are also helped by physical therapy.

Most patients can return to a normal exercise program six months after suffering their compression fracture. Regular exercise is one of the activities recommended to help prevent compression fractures in the future. A well-balanced diet, calcium supplement and occasionally other medications prescribed by your personal physician may be needed to help treat osteoporosis.

Commentary by Iain Kalfas, MD

These articles provide an excellent overview of a complex injury: fractures in the thoracolumbar region of the spine.  These fractures can result in a variety of clinical presentations ranging from mild low back discomfort to complete paralysis.  The author correctly emphasizes the need for early recognition of these injuries in order to prevent serious neurological consequences.  The articles provide a concise description of the more common fracture types in this region and accurately review the accepted management options for each injury type.

Updated on: 06/26/18
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Compression and Wedge Fractures
Iain Kalfas, MD
Head, Section of Spinal Surgery
Dept. of Neurosurgery, Cleveland Clinic
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Compression and Wedge Fractures

Injury or trauma to the spine may cause compression and wedge fractures, which are very painful and require immediate medical attention.
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