- Stable: Compression fractures are rarely unstable.
- Little need for surgery: Most of these injuries do not need surgical intervention.
- Activity modification: Activity modification with or without bracing (6–8 weeks) is management of choice for stable fractures.
- Stable fractures: Stable burst fractures without neurologic deficit can be managed with activity modification with or without bracing (8–12 weeks).
- Unstable fractures: Burst fractures can be unstable with focal kyphosis, neurologic injury, lamina fracture, and facet subluxation. Unstable burst fractures are commonly treated with posterior instrumentation with fusion and decompression.
- Retropulsion: Anterior or lateral corpectomy, followed by posterior instrumentation, may be utilized in patients with significant retropulsion.
Flexion-distraction (Chance fracture)
- Conservative management: Purely bony fracture with good and maintained reduction (supine and standing) could be managed in TLSO brace or casting (8–12 weeks).
- However, most require surgical treatment: This is generally achieved with posterior instrumentation and fusion.
- Unstable: This injury pattern is inherently unstable.
- Surgical technique: Decompression and stabilization with instrumentation and fusion is generally performed for treatment.
Apophyseal fracture and herniation
- Conservative management: Anti-inflammatory medication with or without bracing (8 weeks) is the initial treatment in patients without neurologic deficit.
- Surgical decompression: Patients with failure of conservative management or neurologic deficit may require surgical decompression with or without removal of herniation.
Spinous process/transverse process fracture
- Conservative management: Conservative treatment with pain control and initial activity medication is the treatment.
- These fractures do not require surgical intervention
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