The goals of treatment are pain relief, reversal or stabilization of neurological deficits, and stabilization of the spine.
For the most part, nonoperative treatments are recommended for less severe pathologic fractures. These include taking pain medications, limiting physical activity, and wearing a brace. The brace helps support the back and prevents bending forward, which removes pressure from the fractured vertebrae.
If the fracture is caused by osteoporosis, treatment of the osteoporosis can help prevent additional fractures. Treatment may include calcium and vitamin D supplements, bisphosphonates, and weight bearing exercise.
If the fracture is caused by metastatic cancer, treatment options vary by case. Nonsurgical option for pain relief is radiation therapy or injection of bone cement. Radiation is applied to the area of involvement in the hopes of shrinking the tumor and removing pressure from the nerves. The surgeon may perform a vertebroplasty or a kyphoplasty. During these procedures, the surgeon injects a cement mixture into the fractured bone to stabilize the fracture, treat pain, and prevent a spinal deformity from progressing.
Spine surgery is considered if the spine appears to be unstable or if there is significant compression of the neural elements.
In some cases, the surgeon may need to remove diseased bone to relieve pressure on the spinal cord and nerves. Such procedures may also require a spinal fusion to stabilize the spine until it heals. During a spinal fusion, the surgeon may place a bone graft across the area of instability, allowing the vertebrae to fuse (grow together). The surgeon may also need to perform an internal fixation, using screws and rods, to hold the vertebrae in place while the bone heals.
The surgeon will tailor the treatment to each patient and each situation.
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