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.
All components of treatment have improved greatly in the last decade, says Michael Schaufele, MD, a physiatrist and professor of orthopaedics at Emory University School of Medicine in Atlanta. "We have better interventional options to treat fractures and better treatments to prevent future fractures," he tells WebMD.
The majority of fractures heal with pain medication, reduction in activity, medications to stabilize bone density, and a good back brace to minimize motion during the healing process. Most people return to their everyday activities. Some may need further treatment, such as surgery.
Nonsurgical 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 medicines, bed rest, back bracing, and physical activity.
Pain medications. A carefully prescribed "cocktail" of pain medications can relieve bone-on-bone, muscle, and nerve pain, explains F. Todd Wetzel, MD, professor of orthopaedics and neurosurgery at Temple University School of Medicine in Philadelphia. "If it's prescribed correctly, you can reduce doses of the individual drugs in the cocktail."
Over-the-counter pain medications are often sufficient in relieving pain. Two types of non-prescription medications -- acetaminophen and non-steroidal anti-inflammatory drugs (NSAIDs) -- are recommended. Narcotic pain medications and muscle relaxants are often prescribed for short periods of time, since there is risk of addiction. Antidepressants 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. Newer elastic braces and corsets are more comfortable to wear but don't work, says Wetzel. "There's an old saying, 'The inconvenience of the brace is directly proportional to its effectiveness,'" he tells WebMD. However, braces should be used cautiously and only under a doctor's supervision. Weakening and loss of muscle can occur with excessive use of braces for lumbar conditions.
Osteoporosis treatment. Bone-strengthening drugs such as bisphosphonates (such as Actonel, Boniva, and Fosamax) help stabilize 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:
- Spinal fusion surgery