Edited by Aditya Karhade and Brian Goh - 7/1/2021
Descriptors
Mechanism of injury, osteoporotic vs traumatic
If fracture involves the posterior vertebral cortex, then it is a burst fracture
Workup
Radiographs:
Upright XRs for clinic follow up (e.g. AP/lateral standing lumbar x-rays)
Other imaging:
Request MRI if any concern for new neurologic deficit on exam
Labs:
None (suggest endocrine consult and work-up for osteoporosis)
Other:
None
Management
Need for acute intervention:
None usually indicated; Can also refer to Interventional Radiology for consultation for kyphoplasty or vertebroplasty
Weight-bearing and range of motion:
No bending, twisting, or lifting > 10 pounds until follow-up in spine clinic
Type of immobilization:
Usually no orthosis indicated, but can provide TLSO for patient comfort (not necessary).
More info on orthoses at spine orthoses page
Admission or discharge status:
If isolated injury without neurologic deficit or instability, ED OBS status, PT, pain control, follow-up in spine clinic in 2-week
If isolated injury with neurologic deficit or instability, obtain further imaging, admit to ortho spine for decompression + fusion
If multisystem trauma, admit to trauma surgery (general surgery)
Anticoagulation:
None
Antibiotics:
None
Surgical Indications
Absolute:
Progressive neurologic deficit
Relative:
TLICS score > 4
Not an indication: Back pain