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Bedrest for ten days
0%
12/3424
Oral pain medications, thoracolumbosacral orthosis, and progressive increase in activity level
96%
3300/3424
Posterior percutaneous pedicular fixation from L1 to L5
1%
42/3424
Posterolateral fusion from L2 to L4 with instrumentation
40/3424
Anterior column reconstruction with strut grafting and plate fixation
16/3424
Select Answer to see Preferred Response
Initial treatment of osteoporotic compression fractures without neurologic compromise consists of pain control, progressive increase in activity levels, and a TLSO, or thoracolumbosacral orthosis. Compression fractures are common in the elderly with osteoporosis as a result of low energy trauma. Most of these can be managed without surgery in a brace and oral pain medication. Initial management consists of pain control and a gradual return to activity. If pain continues after 6 weeks of non-operative therapy, kyphoplasty or vertebroplasty are available options. If a neurologic deficit is present, management would include surgical decompression and stabilization. Wood et al. conducted a prospective, randomized trial and showed no significant difference between patients who were treated with and without surgery for a stable thoracolumbar burst fracture in a neurologically intact patient. Gertzbein conducted a study comprised of 1,1019 traumatic thoracolumbar fractures followed prospectively for 2 years. 10.5% were compression fractures while 63.9% were burst fractures. They found 11 positive relationships, including, relative improvement in neurologic status following surgery, anterior surgery compared to posterior surgery was more effective when evaluated using the Manabe et al criteria, and a kyphotic deformity of >30 degrees was associated with more intense back pain. Incorrect Answers: Answer 1: While bedrest can help acute pain, it may lead to worsening osteoporosis, DVT, PE, and deconditioning. Answer 3: This compression fracture is not unstable, and thus, does not require instrumentation. Answer 4: This compression fracture is not unstable, and thus, does not require instrumentation. Answer 5: This compression fracture is not unstable, and thus, does not require instrumentation.
3.6
(35)
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