The treatment of vertebral fractures varies widely. It must be based on the type, cause, location and characteristics of the fracture, and on whether or not there are any neurological symptoms associated with spinal cord injury, compression of the medulla or nerves.
Treatment can either be conservative or surgical, or a combination of both.
Conservative treatment is used for those fractures that are not considered dangerous. That is, in which there is no risk of secondary complications and the patient has no neurological symptoms from the beginning.
This treatment is based on the use of pain-relieving medication. Sometimes it may be necessary to use a corset or orthopedic brace, which can be custom made depending on the type of fracture and its location. If there are metabolic or endocrinological problems, attempts will be made to correct the related causal problems, with or without the help of medications.
Surgical treatment varies, and will depend on the type of fracture, its cause and location. In some cases it may be necessary to inject cement into the vertebra (vertebroplasty, kyphoplasty), especially in the case of osteoporotic fractures, which are refractory to medical treatment.
In unstable fractures, it may be necessary to perform a posterior stabilization of the fracture with the placement of posterior screws, which can be done by percutaneous (minimally-invasive) surgery and/or open surgery. These screws, depending on the type of fracture, can be removed at the time the fracture is considered healed, generally between 8 months and one year.
MORE SEVERE CASES
In more severe cases, a vertebral fusion may be necessary to permanently stabilize the segment affected by the fracture. This surgery can be performed by stages, in addition to the surgical stage for the placement of the screws, mentioned above, it may be necessary to place implants in the anterior part of the spine, which serve to completely or partially replace the vertebra fractured (corporectomy).
In the case of a secondary tumor-related fracture, it may be necessary to remove the entire vertebra (vertebrectomy) for analysis, in which case the vertebra is replaced with an artificial one. In selected cases, just a biopsy will be taken instead of removing the whole vertebra, since there are some types of bone tumors that are treated with drugs (chemotherapy and/or radiotherapy).
Rarely, in cases of injury and/or other causes, urgent surgery is performed to avoid major complications, especially when there is direct compression on the neurological structures (medulla and/or nerves). In these cases, direct decompression of the affected structures may be necessary, performing a posterior laminectomy resection of the posterior elements of the vertebra). Decompression surgery with laminectomy is usually completed by stabilizing the segments with posterior screws with or without anterior support with an artificial vertebra.