Procedure of the Month

You chose: Conservative (non-surgical) measures. - WRONG

Conservative measures can be recommended for the first few weeks’ post-injury, to allow for the natural healing of the vertebral body. In this case, however, the patient reportedly experienced pain for 3 months, and still showed signs of acute fracture with edema. Thus, healing had not occurred over this time frame.

Conservative care typically includes a combination of analgesics, bed rest and back braces.

Effective analgesics for this type of patient would most likely include a narcotic, which, when used long-term, may impact the patient’s already deteriorated quality of life, as recently described(1).

Bed rest, while appropriate for a limited time span post-injury, can result in multiple physical and psychological side effects. Examples of significant clinical side-effects associated with bed rest are deep vein thrombosis (DVT) and pneumonia, both severe conditions for elderly patients. In cases of elderly patients, as seen herein, osteoporosis may be the cause of the initial fracture, and bed rest accelerates bone loss, which could have severe consequences on the other, still intact, spinal levels.

Back bracing may again be effective immediately post-injury, to help treat an acute fracture. In the case of a 5-month old fracture with edema, bracing may not be as effective. Bracing also affects quality of life and as such has low rates of compliance, as it is uncomfortable for the patient, potentially restricts proper breathing and is therefore poorly tolerated, especially by older patients.

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