Expert recommendations for treating vertebral compression fractures (VCF)
The VCF clinical care pathway was developed using the RAND™/UCLA appropriateness method (RAM) to evaluate vertebral augmentation (VA) and non-surgical management (NSM) as treatment options. This summary of patient-specific guidelines is based on the panel’s recommendations.1
Ten signs and symptoms were considered to be most specific for VCF.
History of present illness:
Past medical history, including relative risk factors:
Physical exam:
Of the 576 clinical scenarios: 16% were deemed appropriate for nonsurgical management (NSM), 46% were deemed appropriate for vertebral augmentation (VA), and 38% were uncertain.
After weighing the appropriateness of all advanced imaging modalities (MRI, CT, nuclear bone scan) for patients suspected of having VCF, the panel considered advanced imaging:
The panel agreed on seven key clinical findings used to prescribe vertebral augmentation or non-surgical management.
| Clinical finding | Categories considered |
1. Duration of pain |
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2. Advanced imaging findings (MRI, CT, nuclear bone scan) |
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3. Degree of vertebral height reduction |
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4. Kyphotic deformity |
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5. Progression of vertebral height loss (additional height reduction on radiologic images at follow-up) |
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6. Evolution of symptoms |
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7. Impact of VCF on daily functioning |
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The panel considered 11 conditions to assess the appropriateness of vertebral augmentation. Full agreement was reached on recommendations for absolute and relative contraindications.
Absolute contraindication:
Active infection at surgical site
Untreated blood-borne infection
Strong contraindication:
Usually a contraindication:
Relative contraindication:
Generally not a contraindication:
Panel consensus was reached on the following statements related to patient follow up:
After either VA or NSM, a follow-up visit should be planned at two to four weeks.
In patients with a satisfactory result of VA at first follow-up (two to four weeks after the procedure) there is generally no need for further post-operative monitoring. Follow-up for management of the underlying pathology does not need to be managed by the proceduralist.
All patients presenting with VCF should be referred for bone mineral density evaluation and for osteoporosis education and subsequent treatment as indicated.
All patients with VCF should be instructed to take part in an osteoporosis prevention/treatment program.
If symptoms are not resolved at follow-up, repeat imaging (preferably MRI) is mandatory.
If the pain is not resolved after VA, a repeat augmentation (at the same level) may be considered, but does require a careful diagnostic evaluation to identify any other sources of pain (additional fractures, facet arthropathy, etc.).
