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A 79-year old female sustains a low energy fall and is hospitalized for low back pain that prevents her from ambulating. She denies any symptoms of buttock or leg pain. On physical exam she has point tenderness over the T12 vertebral body. Examination of her lower extremities is normal. Radiographs are shown in Figure A and B. An MRI is performed which shows signal intensity within the T12 vertebral body on T2-weighted images and no evidence of retropulsion or spinal cord compression. Which of the following statements is true regarding this injury pattern?
There is no association between this fracture and future osteoporotic fragility fractures.
Prospective, randomized, double blinded studies have recently showed improvement with vertebroplasty.
2-year mortality rates are roughly equivalent to those associated with hip fractures.
This fracture results in chronic back pain in the majority of patients regardless of treatment.
Neurologic deterioration is a common complication with this injury pattern.
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In the treatment of acute osteoporotic compression fractures, vertebroplasty has been shown to have which of the following benefits in randomized, double-blind, placebo-controlled trials compared to nonoperative treatment.
Improvement in pain at 3 months, but not difference at 1 year
Improvement in function at 3 months, but not difference at 1 year
Improvement in pain at 2 week and at 1 year, but no difference in function
Improvement in pain and function at all time points
No benefit at any time point
A 71-year-old female who has no significant medical comorbidities presents to the emergency department after sustaining a compression fracture of L2. The patient has moderate back pain but is neurologically intact. Radiographs of the entire spine reveal a L2 compression fracture with 30% loss of vertebral body height loss and 15 degrees of local kyphosis. What would be the appropriate management for this patient?
Bedrest for ten days
Oral pain medications, thoracolumbosacral orthosis, and progressive increase in activity level
Posterior percutaneous pedicular fixation from L1 to L5
Posterolateral fusion from L2 to L4 with instrumentation
Anterior column reconstruction with strut grafting and plate fixation
HPI - Back pain of 1 year's duration. Recently worse.
How would you manage this patient?
HPI - Severe Back pain since 12 days, with particular exacerbation at night. No history of trauma. Doesn't complain of any numbness in any of her limbs. No Bladder/ Bowel involvement. Has Loss of appetite. No loss of weight recently. Had a febrile illness for three days 15 days ago.
What treatment would you suggest for her Back pain?