Spinal Fractures
OVERVIEW:
Spinal fractures represent a serious orthopaedic injury. Spinal fractures can be caused by trauma, however, people with conditions that weaken the bone such as osteoporosis, tumors, or other underlying conditions may also develop fractures during normal daily activities.
The most common fracture of the spine occurs in the thoracic (midback) and lumbar spine (low back) or at the connection between the middle and low back (thoracolumbar junction) [Figure 1]. These fractures are usually occurring as a result of a high velocity accident such as a motor vehicle accident or fall from a height. Because spinal fractures may be the result of high energy trauma, the patient may also have other injuries that require treatment. In severe cases the spinal cord may be injured as the result of the spinal fracture. For patients with high energy trauma, emergency evaluation and treatment is required.
Figure 1
SYMPTOMS:
The most common symptoms of a spinal fracture are moderate to severe pain in the back that is increased with movement. When the spinal cord or spinal nerves are involved, numbness, tingling, weakness, or bowel and bladder dysfunction may also occur. For patients with high energy trauma, other injuries may also occur. Patients who lose consciousness or "black out" during a trauma require emergency evaluation.
CAUSES:
Fractures of the spine are typically associated with trauma such as:
- Motor vehicle accidents
- Fall from height
- Sporting accidents
- Violent act
Fractures that occur during daily activities are most commonly associated with conditions that may weaken the bone including:
- Osteoporosis
- Spinal tumors
- Infections
EMERGENCY EVALUATION:
Emergency evaluation is required for patients who have spinal fractures that occured in a high energy incident or any patients who black out at the time of their injury. In the emergency room a physician will monitor the patient's vital signs as well as evaluate and treat associated injuries.
For patients with spinal fractures, diagnostic tests including x-rays, CT, and MRI scans are used as appropriate to identify the location of the fracture as well as the possibility of any neurologic compression [Figure 2]. The doctor will evaluate the patient's neurologic status including the ability to move, feel, and sense normally in all four limbs. In addition, the doctor will check reflexes and more specialized tests as appropriate.
Figure 2: CT scan demonstrates a common fracture knows as a “Chance Fracture.” The front part of the bone is compressed forward (red arrow) and a crack is seen in the back of the bone (yellow arrow).
TREATMENT:
Treatment for fractures of the spine will depend on the location and type of fractures as well as other areas that may be injured. For most patients non-operative treatment of the fracture is appropriate. For patients with neurologic compromise or unstable fractures, surgical intervention may be appropriate in order to stabilize the fracture and assist with healing, as well as remove compression from nerve structures.
For patients with low energy fractures due to osteoporosis (compression fractures), treatment options include observation, bracing, and pain management [Figure 3]. For some patients a minimally invasive procedure including vertebroplasty and kyphoplasty may help to prevent further compression and to improve pain.
Figure 3
REHABILITATION:
Regardless of the specific type of fracture or treatment, rehabilitation will be necessary for any patient with a spinal fracture once the injury has healed. The goal of rehabilitation treatment is to regain mobility and help the patient return to their pre-injury level of function. Rehabilitation also works to reduce pain and minimize disability.
Fractures of the neck (cervical spine) usually occur as a result of high energy trauma. There are seven bones in the neck and a break in any of those may be referred to as a "broken neck." Any fracture in the neck has serious consequences because the spinal cord runs through the center of the neck vertebrae. Damage or injury to the spinal cord can result in paralysis or death.
All patients with trauma who develop cervical fractures should be evaluated in an emergency room setting. For patients with more minor injuries without neurologic symptoms, evaluation in the office may be appropriate. Patients with an acute neck injury will usually complain of severe neck pain. They may also have pain, numbness, or weakness radiating to the arms or legs if nerve compression is present.
All patients with neurologic symptoms after a neck injury should be evaluated emergently.
TREATMENT:
Treatment will depend on the type of fracture as well as the amount of neurologic compression. Minor fractures can be treated with cervical bracing. More complex fractures or fractures with spinal cord compression may require traction, surgery, or some combination of the above.
REHABILITATION:
Spinal rehabilitation is required after all types of cervical fractures to regain mobility and reduce pain.
PREVENTION:
Important ways to protect yourself from a broken neck include:
- Always wear a seat belt when riding in a car
- Always wear protective equipment when playing sports and follow all regulations
- Never dive head first into shallow pool or swimming area
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