A Pain In The Butt (and Back) - Page #4

Working Diagnosis:
Acute, traumatic multilevel lumbar compression fractures

Physical therapy, modification of activity, pain control with NSAIDs

Patient recently completed physical therapy for core strengthening with complete resolution of his back and leg symptoms.

He is currently back to his normal level of activity and back to horseback riding. We are considering future evaluation of his bone density, given his age, traumatic, multilevel compression fractures and prior compression fracture at T1 from a previous riding accident.

Author's Comments:
Osteoporosis is the most common cause of vertebral compression fractures (VCF). Trauma is a common cause of VCF in patients without osteoporosis. Conservative treatment: pain control, modifying activities, bracing, and physical therapy.
Vertebroplasty or kyphoplasty indicated for patients with intractable pain despite conservative treatment, neurologic deficits or extreme spinal deformity. There is insufficient evidence for universal osteoporosis screening in men.

Editor's Comments:
Be aware compression fractures can appear similar as a burst fracture. Also in a patient with a compression fracture, make sure the posterior elements are intact. Don't overlook the value of a CT scan in looking at bony anatomy. For compression fracture > 50% of the height, consider the posterior elements could be disrupted. This is where the CT scan would be useful in evaluating the anatomy.

1. Alexandru D, So, W. Evaluation and Management of Vertebral Compression Fractures. Perm J 2012 Fall;16(4):46-51
2. Longo U, et al. Osteoporotic vertebral fractures: current concepts of conservative care. British Medical Bulletin (2012) 102 (1): 171-189.
3. Bennell KL, et al. Effects of an exercise and manual therapy program on physical impairments, function and quality of life in people with osteoporotic vertebral fracture. BMC Musculoskelet Disorder 2010 Feb 17;11:36
4. McGuire, Robert. AAOS Clinical Practice Guideline: The Treatment of Symptomatic Osteoporotic Spinal Compression Fractures. J Am Acad Orthop Surg 2011;19:183‐184
5. USPSTF. Screening for Osteoporosis: USPSTF Recommendation Statement. Ann Intern Med. 2011;154:356-364

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