Management of Vertebral Compression Fractures

Assessment of Fracture Stability

A stable fracture is indicated by the absence of neurological deficits, which suggests a lower risk of complications 3
A 10% loss of vertebral body height is considered mild and may not require immediate intervention 1
The absence of retropulsion, or bone fragments in the spinal canal, means a lower risk of neurological compromise 2
Fractures without significant deformity, defined as less than 15% kyphosis and less than 10% scoliosis, are considered stable 1

Pain control with appropriate analgesics is essential for patient comfort 1
A cervical collar may be considered for comfort and mild stabilization 3
Discharge with outpatient follow-up is recommended rather than transfer for immediate specialist consultation 2

Surgical intervention is reserved for patients with neurologic deficits, which may indicate a more severe injury 2, 3
Significant spinal deformity, such as more than 15% kyphosis, may require surgical intervention 1
Spinal instability or retropulsion of bone fragments into the spinal canal may also require surgical consultation 2, 3

The American College of Radiology recommends conservative management for uncomplicated vertebral compression fractures 2
The natural history of most vertebral compression fractures is gradual improvement in pain over 2 to 12 weeks, with variable return of function 1
The ACR Appropriateness Criteria suggest that surgical intervention is reserved for patients with neurologic deficits, spinal deformity, or spinal instability 1

Missed instability can occur if careful documentation of neurological examination is not performed to establish a baseline 4