Spine Case 8 ED Management

Initial management of minimal to moderate compression fractures (< 50% loss of height or < 30 degrees of angulation) with an intact posterior column includes analgesics, TLSO brace (thoracic-lumbar-sacral-orthosis), and limited ambulation. Pain control will often determine whether these patients require admission. These patients may subsequently require physical therapy.

Fractures that may require surgery include those with refractory pain, progression of fracture, neurologic compromise, burst fractures, and those with > 50% loss of vertebral body height or > 30 degrees of angulation. Consult a spine specialist emergently in these scenarios, and when infection is diagnosed.