Treatment for spinal compression fractures

If osteoporosis has caused a spinal compression fracture the treatment should address the pain, the fracture, and the underlying osteoporosis to prevent future fractures.

The majority of fractures heal with pain medication, reduction in activity, medication to stabilise bone density and a back brace to minimise motion during the healing process. Most people return to their everyday activities. Some may need further treatment, such as surgery.

Non-surgical treatment for spinal compression fractures

Pain from a spinal compression fracture allowed to heal naturally can last as long as three months. But the pain usually improves significantly in a matter of days or weeks.

Pain management may include analgesic pain medicine, bed rest, back bracing, and physical activity.

Pain medication. Over-the-counter pain medication is often sufficient in relieving pain. Two types of non-prescription medication, paracetamol and non-steroidal anti-inflammatory drugs (NSAIDs), are recommended. Opioid pain medication and muscle relaxants are often prescribed for short periods of time, since there is a risk of addiction. Anti-depressants can also help relieve nerve-related pain.

Activity modification. Bed rest may help with acute pain but it can also lead to further bone loss and worsening osteoporosis, which raises your risk for future compression fractures. Doctors may recommend a short period of bed rest for no more than a few days. However, prolonged inactivity should be avoided.

Back bracing. A back brace provides external support to limit the motion of fractured vertebrae, much like applying a cast on a broken wrist. The rigid style of a back brace limits spine-related motion significantly, which may help reduce pain. However these should be used  for only a short period of time since they can cause further weakness in the supporting muscles.

Osteoporosis treatment . Bone-strengthening drugs such as bisphosphonates (such as alendronic acid, risedronate sodium and ibrandronic acid) help stabilise or restore bone loss. This is a critical part of treatment to help prevent further compression fractures.

Surgical treatment for spinal compression fractures

When chronic pain from a spinal compression fracture persists despite rest, activity modification, back bracing, and pain medication, surgery is the next step. Surgical procedures used to treat spinal fractures are:

• vertebroplasty
• kyphoplasty
• spinal fusion surgery

Vertebroplasty and kyphoplasty

These procedures for spinal compression fractures:

• involve small, minimally invasive incisions, so they require very little healing time.
• utilise acrylic bone cement that hardens quickly, stabilising the spinal bone fragments and therefore stabilising the spine immediately.
• most patients go home the same day or after one night's hospital stay.

Vertebroplasty. This procedure is effective for relieving pain from spinal compression fractures and helping to stabilise the fracture. During this procedure:

• a needle is inserted into the damaged vertebrae.
• x-rays during the procedure help ensure that it's done with accuracy.
• the doctor injects a bone cement mixture into the fractured vertebrae.
• the cement mixture hardens in about 10 minutes.
• the patient typically goes home the same day or after a one-night hospital stay.

Kyphoplasty: This procedure helps correct the bone deformity and relieves the pain associated with spinal compression fractures. During the procedure:

• through a half inch cut in the back, a tube is inserted into the damaged vertebrae. X-rays help ensure the accuracy of the procedure.
• a thin catheter tube, with a balloon at the tip, is guided into the vertebra.
• the balloon is inflated to create a cavity in which liquid bone cement is injected.
• the balloon is then deflated and removed, and bone cement is injected into the cavity.
• the cement mixture hardens in about 10 minutes.