Decisions to Operate for Spinal Fracture in Aging Adults
When an older adult reports back pain, doctors think a fracture may be a possible cause. X-rays may be taken with the patient lying down on his or her back (supine). Judging by the height of the bones, the angle of the spine, and the patient's symptoms, the doctor may advise surgery. The goal of the operation is to stabilize the spine and hold it in one place until the fracture heals.

Many patients can be treated without surgery. But doctors in England noticed X-rays taken three months after fracture showed increased deformity in some of these patients' spines. The authors did a study of 28 patients with vertebral fractures that were treated nonoperatively. X-rays were taken with the patient supine and also in sitting or standing position. The weightbearing X-rays were compared to the supine X-rays.

Twenty-five percent of the patients treated without surgery showed collapsing bones. Putting weight through the spine made the fracture worse. This finding changed the treatment plan from nonoperative to operative.

The authors conclude that even though spine fractures can be treated without surgery, there are some patients who would do better with an operation. These patients will likely have less deformity and compression of the vertebral bones. Weightbearing X-rays can be used to make this decision. Regular supine X-rays don't always show how much damage is present. Changes occur when the patient sits or stands and puts weight through the spine.
References
J. S. Mehta, MCh (Orth), et al. Weight-Bearing Radiographs in Thoracolumbar Fractures: Do They Influence Management? In Spine. March 1, 2004. Vol. 29. No. 5. Pp. 564-567.