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Spinal fractures


Spinal injuries can range from relatively mild ligament and muscle strains (such as whiplash), to fractures and dislocations of the bony vertebrae (vertebrae fractures), to debilitating spinal cord injuries. Spinal fractures and dislocations can pinch, compress, and even tear the spinal cord. Treatment of spinal fractures depends on the type of fracture and the degree of instability.
Fractures can occur anywhere along the spine. Five to ten percent occur in the neck (cervical fractures) region. Sixty four percent occur in the lower back (lumbar fractures) region.

 

Classification of Fractures

There are numerous classifications for fractures. In general, spine fractures fall into three categories:

  • Fractures: when more pressure is put on a bone than it can stand, it will break. The most common type of spine fracture is a vertebral body compression fracture. Sudden downward force shatters and collapses the body of the vertebrae. If the force is great enough, it may send bone fragments into the spinal canal, called a burst fracture. People affected by osteoporosis, tumors, and certain forms of cancer that weaken bone are prone to vertebral compression fractures (VCF). The fracture appears as a wedge-shaped collapse of the vertebra. Multiple VCFs can cause a forward hunch of the spine called kyphosis.
  • Dislocations: when the ligaments and/or discs connecting two vertebrae together are stretched or torn, the bones may come out of alignment. For example, when the rapid forward motion of the upper body against a seat belt pulls apart the vertebra and stretches the ligaments. A dislocated vertebra can cause instability and spinal cord compression. They usually require stabilization surgery or a brace.
  • Fracture-dislocations: occur when bone is broken and the ligaments are torn. These fractures are usually unstable, tend to be very debilitating, and are often surgically repaired.

Compression Fractures of the Spine

A compression fracture occurs when the normal vertebral body of the spine is squished, or compressed, to a smaller height. This injury tends to happen in two groups of people. First, are patients who are involved in traumatic accidents. When a load placed on the vertebrae exceeds its stability, it may collapse. This is commonly seen after a fall. The second, and much more common, groups of patients are those with osteoporosis.
Osteoporosis is a condition that causes a thinning of the bone. As the bone thins out, it is less able to support a load. Therefore patients with osteoporosis may develop compression fractures without severe injuries, even in their daily activities.

Signs and Symptoms of Spinal Fractures

Spinal fractures signs and symptoms vary depending on the severity and location of the injury. They include back or neck pain, numbness, tingling, muscle spasm, weakness, bowel/bladder changes, and paralysis. Paralysis is a loss of movement in the arms or legs and may indicate a spinal cord injury. Not all fractures cause spinal cord injury and rarely are the spinal cord completely severed.

Causes of Fractures

Car accidents (45%), falls (20%), sports (15%), acts of violence (15%), and miscellaneous activities (5%) are the primary causes of fractures of the spine. Diseases such as osteoporosis and spine tumors also contribute to fractures.

Who is affected?

80% of patients are aged 18-25 years. Men are 4 times more likely to have a traumatic spinal fracture than women.

Treatment for Spinal Fractures

Spinal fractures treatment begins with pain management and stabilization to prevent further injury. Other body injuries (e.g., to the chest) may be present and need treatment as well. Depending on the type of fracture and its stability, bracing and/or surgery may be necessary.

  • Braces and Orthotics do three things,
    1. maintains spinal alignment
    2. immobilizes your spine during healing
    3. controls pain by restricting movement
    Stable fractures may only require stabilization with a brace, such as a rigid collar (Miami J) for cervical fractures, a cervical-thoracic brace (Minerva) for upper back fractures, or a thoracolumbar-sacral orthosis (TLSO) for lower back fractures. After 8 to 12 weeks the brace is usually discontinued. Unstable neck fractures or dislocations may require traction to realign the spine into its correct position. A halo ring and vest brace may be required.
  • Instrumentation and Fusion are surgical procedures to treat unstable fractures. Fusion is the joining of two vertebrae with a bone graft held together with hardware such as plates, rods, hooks, pedicle screws, or cages. The goal of the bone graft is to join the vertebrae above and below to form one solid piece of bone. It may take several months or longer to create a solid fusion.
  • Vertebroplasty and Kyphoplasty are minimally invasive procedures performed to treat compression fractures commonly caused by osteoporosis and spinal tumors. In vertebroplasty, bone cement is injected through a hollow needle into the fractured vertebral body. In kyphoplasty, a balloon is first inserted and inflated to expand the compressed vertebra before filling the space with bone cement.

Authored By: Dr. S. V. Santpure

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