Management of Lumbar Spine Fractures

Diagnostic Evaluation

The American College of Radiology recommends MRI of the lumbar spine without contrast as the diagnostic imaging of choice to evaluate fracture characteristics and exclude pathological causes 1
Simple radiographs have insufficient sensitivity and should be complemented with cross-sectional imaging 2, 3
The presence of neurological deficits requires immediate surgical referral 1
Instability visible on imaging requires immediate surgical referral 1
Suspected pathological fracture requires MRI with and without contrast, and possibly biopsy 1

The American College of Radiology recommends a minimum of 3 months of conservative medical treatment before considering intervention 4, 1
Calcitonine for the first 4 weeks can reduce pain in acute fractures 1
Non-steroidal anti-inflammatory drugs can be used according to tolerance 3
Nerve block of the L2 root can be considered for referred pain 5
Follow-up at 4-6 weeks is necessary to evaluate the response to initial treatment 1

The American College of Radiology recommends immediate surgical referral for patients with neurological deficits 1
Immediate surgical referral is also necessary for patients with documented spinal instability 1
Pathological fracture suspected or confirmed requires multidisciplinary management (interventional radiology, surgery, oncology radiotherapy) 1
Delayed surgical referral can be considered for patients with severe and progressive pain despite 3 months of conservative treatment 1
Significant spinal deformity or progressive kyphosis requires delayed surgical referral 1
Pulmonary dysfunction secondary to the fracture requires delayed surgical referral 1

The American Academy of Orthopaedic Surgeons recommends using autologous bone graft to optimize fusion rates, particularly in patients with compromised bone quality 6
Posterior decompression and in situ fusion may be necessary for cases of severe instability or multiple fractures 6

The American Academy of Orthopaedic Surgeons strongly recommends against using vertebroplasty for osteoporotic fractures 1