Treatment of T8 Compression Fracture

Initial Management

The American College of Radiology recommends conservative medical management for 2-12 weeks, including analgesics, early mobilization, and optional bracing, for a T8 compression fracture without neurological deficits, as both braced and non-braced approaches show equivalent outcomes 1, 2
Pain control with NSAIDs as first-line agents is recommended, with cautious use of narcotics only when necessary due to risks of sedation, falls, and deconditioning 1
Early mobilization is critical to prevent complications of immobility, including decreased bone mineral density, muscle strength loss, and increased mortality 3

Vertebral augmentation, such as vertebroplasty or kyphoplasty, should be offered if pain persists after 3 months of conservative therapy, or if severe pain requires parenteral narcotics or hospitalization, as it provides rapid, marked improvement in pain and function compared to continued conservative therapy 1, 3
The American College of Radiology recommends vertebral augmentation for patients with failure of conservative therapy, defined as pain refractory to oral medications after 3 months 1
Vertebroplasty has been shown to be more effective than continued medical treatment in patients who have failed conservative therapy, while kyphoplasty shows substantial pain relief and improved mobility, though it costs approximately 2.5 times more than vertebroplasty with no clear superiority demonstrated 3, 5

Surgical intervention should be reserved for patients with neurological deficits, significant spinal instability, or severe vertebral collapse with canal compromise, as recommended by the American Academy of Orthopaedic Surgeons 2, 4

Prolonged bed rest should be avoided, as it causes deconditioning, bone loss, and increased mortality 3, 4
Overuse of narcotics should be avoided, as it leads to sedation, falls, and decreased physical conditioning 1, 4