Conservative Treatment for Vertebral Compression Fractures

Treatment issues for vertebral compression fractures?

Hello, Doctor: My grandmother is approximately 83 years old.
She fell about a month ago and initially had no external injuries or bruising.
The next day, she experienced severe pain in her lower back (especially when getting in and out of bed).
She attended a general rehabilitation clinic for two weeks (with electrotherapy, shortwave therapy, and heat application), but there was no improvement.
A few days ago, she consulted an orthopedic specialist, and X-rays revealed compression fractures in both the thoracic and lumbar vertebrae.
The doctor believes that the lumbar compression fracture resulted from the fall, while the thoracic fracture was likely from a previous, unnoticed injury.
Currently, she has been advised to wear a back brace and take pain medication for a week, with a follow-up appointment in three months.
After wearing the brace for three days, she is able to walk and sit without pain, but still experiences some soreness.
When lying down without the brace, she still has pain.
I have found limited information online regarding conservative treatment with a back brace, so I would like to ask: 1.
Under what circumstances of bone healing would it be considered unnecessary to continue wearing the back brace? 2.
What would be the expected changes in the course of conservative treatment that would be considered normal? (For example, when can we expect to be pain-free within a few weeks, etc.) 3.
When sleeping without the brace, if she needs to get up at night to use the bathroom up to three times, should she put on the brace each time before getting up (i.e., put it on while lying down before standing up)? 4.
Is it true that the primary approach for treating compression fractures is usually conservative treatment, and only if that is ineffective would minimally invasive procedures like vertebroplasty be considered? Is there a so-called "golden period" for vertebroplasty treatment? I apologize for the many questions, some of which may be overly detailed.
I am concerned about her current condition and unsure which treatment course is more suitable after learning about the minimally invasive vertebroplasty.
Thank you for your assistance, Doctor.

WW, 20~29 year old female. Ask Date: 2016/03/17

Dr. Shi Guozheng reply Orthopedics

1.
After three months, the fracture has nearly healed, so it is no longer necessary to wear it.

2.
The pain should subside in about four weeks.

3.
It is not necessary to wear the brace continuously.

4.
Injecting bone cement can provide immediate pain relief; it is generally better to proceed with the injection as soon as possible, as the effectiveness decreases after two weeks.
Conservative treatment will also lead to improvement.

Reply Date: 2016/03/17

More Info

Dear Patient,
Thank you for your inquiry regarding the conservative treatment of vertebral compression fractures, particularly in the context of your grandmother's recent injury. It's understandable to have many questions, especially when it comes to the health of a loved one. Let’s address your concerns systematically.

1. When Can the Brace Be Discontinued?
The use of a brace in the treatment of vertebral compression fractures is primarily aimed at providing stability and reducing pain during the healing process. Typically, a brace may be worn for about 6 to 12 weeks, depending on the severity of the fracture and the patient's overall health. The decision to discontinue the brace is usually based on clinical evaluation, including the patient's pain levels, mobility, and imaging studies that show signs of healing. Generally, if the patient can perform daily activities without significant pain and imaging shows that the fracture is healing (e.g., no further collapse of the vertebra), the brace may be discontinued.

2. Expected Changes During Conservative Treatment:
In the initial weeks of conservative treatment, it is common for patients to experience varying levels of pain and discomfort. Typically, patients may start to notice a reduction in pain within a few weeks, often around 4 to 6 weeks, as the body begins to heal. However, complete pain relief may take longer, and some residual discomfort can persist even after the fracture has healed. Regular follow-up appointments are essential to monitor progress and adjust treatment as necessary.

3. Wearing the Brace at Night:
It is advisable for your grandmother to wear the brace when getting out of bed, especially if she is experiencing pain when moving. While it may not be necessary to wear the brace while lying down, putting it on before getting up can help provide support and prevent further injury. If she needs to get up multiple times during the night, it would be prudent to wear the brace each time to ensure safety and stability.

4. Conservative Treatment as First-Line Therapy:
You are correct that conservative treatment is typically the first approach for managing vertebral compression fractures. This includes the use of braces, pain management, and physical therapy. If conservative measures fail to provide adequate relief or if the fracture is unstable, then more invasive options, such as vertebroplasty or kyphoplasty (the "bone cement" procedures), may be considered. These procedures are generally most effective when performed within a few weeks of the injury, often referred to as the "golden period" for intervention. Delaying treatment beyond this window may reduce the effectiveness of these procedures.

In conclusion, it is essential to maintain open communication with your grandmother's healthcare providers to ensure that her treatment plan is tailored to her specific needs. Regular assessments will help determine the best course of action as she progresses through her recovery. If you have further questions or concerns, do not hesitate to reach out to her medical team for clarification.

Wishing your grandmother a smooth recovery.

Sincerely,
Doctor Q&A Teams

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