Conservative management: The first line of defense
For many elderly patients with stable compression fractures, the initial approach is non-surgical, or conservative, management. The goal is to control pain, allow the fracture to heal naturally, and maintain as much mobility as possible to avoid complications associated with prolonged immobility, such as pneumonia and pressure ulcers.
Medications for pain and bone health
Pain management is a cornerstone of conservative treatment. For acute, severe pain, opioid analgesics may be used for a short duration, but they carry risks such as constipation and confusion in the elderly. Nonsteroidal anti-inflammatory drugs (NSAIDs) can be effective for shorter-term pain, though their long-term use in this population is often discouraged due to potential side effects like gastrointestinal bleeding. Beyond pain relief, treating underlying osteoporosis is critical to preventing future fractures.
- Bisphosphonates: These medications slow bone loss and stabilize bone density.
- Calcitonin: Available as a nasal spray, calcitonin may help reduce pain from recent fractures.
- Teriparatide: This injectable medication encourages new bone formation, improving bone density.
- Calcium and Vitamin D: Supplements are often prescribed to support bone health.
Bracing and activity modification
In some cases, a back brace, such as a Thoracolumbosacral Orthosis (TLSO), may be recommended to limit spinal movement and reduce pain. While braces can be effective, they must be used cautiously in the elderly, as long-term use can weaken core muscles. A doctor may recommend wearing a brace for 4 to 12 weeks, based on the fracture's location and severity. Patients should also avoid high-impact activities, heavy lifting, and excessive bending or twisting of the spine during the healing period. Early mobilization with safe, low-impact activities like walking is encouraged to prevent secondary complications from inactivity.
Physical therapy and fall prevention
Physical therapy is a vital component of conservative care. A physical therapist can create a program focused on back-extensor strengthening exercises, balance training (like Tai Chi), and posture correction. This helps improve spinal stability and reduces the risk of future falls, a common cause of compression fractures.
Minimally invasive surgical options
If conservative treatments fail to provide adequate pain relief after several weeks or if the pain is severe from the outset, a doctor may recommend a minimally invasive vertebral augmentation procedure. The two main options are kyphoplasty and vertebroplasty.
Kyphoplasty vs. Vertebroplasty
| Feature | Kyphoplasty | Vertebroplasty |
|---|---|---|
| Procedure | A balloon is first inflated inside the vertebra to restore lost height and create a cavity before bone cement is injected. | Bone cement is injected directly into the fractured vertebra without a balloon. |
| Restores Height | A key benefit is the potential to restore some of the vertebral height lost due to the fracture. | Does not actively restore vertebral height. |
| Effectiveness | Studies suggest it offers significant pain relief and may reduce the risk of future fractures. | Can provide good pain relief, but some studies have questioned its superiority over sham procedures. |
| Risk of Cement Leakage | Generally considered to have a lower risk of cement leakage because the balloon creates a contained cavity. | Has a slightly higher risk of cement leakage, which can cause complications if it enters the spinal canal or bloodstream. |
When is surgery recommended?
Surgery may be the preferred option for elderly patients with severe, persistent pain that limits their daily activities and mobility, especially if it was caused by a recent fracture. The decision also depends on the patient's overall health and the specific characteristics of the fracture. Both vertebroplasty and kyphoplasty are typically outpatient procedures that offer relatively fast recovery and immediate stabilization of the vertebra.
Post-treatment care and prevention
Regardless of the treatment path, comprehensive post-fracture care is essential for the elderly. This includes continuing osteoporosis treatment to prevent future breaks. Physical therapy should continue to improve strength and balance, and patients should be educated on how to perform daily activities safely to protect their spine. Addressing lifestyle factors, such as diet and fall hazards, is also important. For more authoritative information on spinal compression fractures, consider reviewing resources from organizations like the American Academy of Orthopaedic Surgeons.
Conclusion
For elderly patients with compression fractures, treatment is not a one-size-fits-all approach. Initial management often involves a conservative strategy focused on pain control, activity modification, and rehabilitation, which is effective for many. When severe, persistent pain or immobility is an issue, minimally invasive procedures like kyphoplasty and vertebroplasty offer effective alternatives for stabilizing the spine and providing rapid pain relief. Regardless of the chosen path, long-term success relies on addressing the underlying causes, most commonly osteoporosis, and committing to ongoing physical therapy and fall prevention to minimize the risk of further fractures. A collaborative approach involving the patient, their family, and a team of healthcare professionals is key to optimizing outcomes and enhancing quality of life.
