I was in a car accident and fractured my thoracic spine in two places. I’ve been trying to get by without surgery, but I notice the pain is getting worse and so is my posture. Should I wait and see if this is going to get better? Or should I go for the surgery originally recommended by the doctor on call at the hospital where I went at the time of the accident?

Persistent pain, deteriorating neurologic status, or residual deformity all point to the need for follow-up care. Surgery to stabilize the spinal segment may be needed, but it’s possible an orthosis (trunk and back brace) will be enough.

Immobilization is usually avoided early on because of the complications that can occur. But in some cases, immobilization is the treatment of choice and should not be avoided. Spinal injuries often lead to poor outcomes and low rates of return to work and function. This is true for young adults but even moreso for the older adult with osteoporosis or other health problems.

You may want to begin with a medical consult with an orthopedic surgeon. After taking a history and performing a clinical exam, he or she will present you with your options for treatment. Any neurologic involvement can become permanent. Treatment is aimed at preventing long-term complications and restoring full function.