Spinal Fractures


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Understanding Spinal Fractures

Spinal fractures or a dislocation of one or more vertebrae in a spine caused by trauma is considered a serious orthopedic injury. The majority of these fractures occur as a result from a high velocity accident and can occur in the neck (cervical spine), mid back (thoracic spine) or low back (lumbar spine). High velocity accidents are associated with trauma from motor vehicle accidents, a fall from height, or sporting accidents. Other reasons why dislocation can occur could also be related to soft bones. If a person has a history of soft bones called osteoporosis, then that individual could be more vulnerable to trauma. Also, there are instances where people can develop a fracture without having any injury or trauma. Then those individuals need to be evaluated for possible cancer. 

Fractures of the neck usually occur as a result of high energy trauma and are uncommon in other situations. Any fracture of the cervical spine has serious consequences because of its location in relation to the spinal cord. A cervical fracture can cause bone fragments to pinch and damage the spinal cord or surrounding nerves which branch off of the spinal cord. Damage or injury to the spinal cord can result in paralysis or death. This is why all fractures should be evaluated to understand the stability of the spine and prevent any further nerve damage.  All patients with trauma who develop cervical fractures should be evaluated. Patients with high energy trauma or those who lose consciousness also require urgent emergency evaluation and treatment. 

Depending on how severe your injury is, you may experience pain, difficulty walking, or be unable to move your arms or legs (paralysis). The most common symptom of a spinal fracture is moderate to severe pain that is increased with movement. Treatment depends on the type of fracture and the degree of instability. Many fractures heal with conservative treatment; however severe fractures may require surgery to realign the bones.

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Most vertebral fractures, regardless of where they are located, are associated with mild to severe pain (depending on the location of the spinal fracture) which worsens with any type of movement. In more severe cases, the fracture may cause nerve symptoms including numbness, tingling, muscle spasms, weakness, bowel/bladder problems or even paralysis. Sometimes the symptoms can present as intermittent or temporary. It is important to see medical evaluation if any symptoms persist.

When to Seek Treatment

If you’re noticing symptoms associated with Spinal Fractures and suspect a spinal issue, it’s crucial to consider consulting a board-certified spinal specialist. Reach out promptly to a certified spine surgeon for an accurate diagnosis and timely treatment. Early intervention can significantly improve your overall well-being and provide a broader range of treatment options, which may decrease as symptoms persist. The key to a successful and speedy recovery lies in addressing the root of the pain with your spine specialist as soon as symptoms arise.

While many people experience day-to-day back or neck pain, dismissing it as soreness, this may not be the case for everyone. If your pain persists for more than 10 days, it should be taken more seriously. Evaluate such prolonged pain with a spine surgeon to identify the root issue and determine the appropriate treatment. Additionally, be attentive to other signs related to back or neck pain that should not be ignored, including pain accompanied by fever, pain associated with loss of bladder control, and weakness/tingling/numbness in your arms or legs.

It’s important to note that these are general guidelines based on our expertise in spine care over the past three decades, recognizing that each patient’s symptoms may be unique.

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Common Causes & Types of Spinal Fractures

Spinal dislocation may occur due to a variety of factors. The most common cause is related to trauma such as high velocity car accidents, fall from height, or high impact sports. Other causes may include pathologic fractures related to osteoporosis or cancer.

There are several types of spinal fractures based on the pattern of injury and the extent of spinal cord injury. Below are the more common fractures:

Compression Fracture

People can develop spinal fractures unrelated to trauma. Fractures that occur during daily activities are most commonly due to weakened bones from osteoporosis, tumors, or other medical conditions and rarely have spinal cord or nerve involvement. The front of the vertebrae fractures and loses height however the back, posterior, the part remains stable. The shape of the vertebrae is usually described as a “wedge”. Think of it as a soda can that gets compressed but it’s still intact.  It can be painful or asymptomatic and is usually a stable fracture. These fractures can possibly heal over time without much treatment needed. 

Axial Burst Fracture

This is more advanced than a compression fracture. This is usually caused by a fall from a significant height, landing on the feet or your bottom. The vertebra loses height on both the front and back sides, causing a decrease in the overall height of the vertebrae. There may be fragments of the vertebrae that separate and may injure the spinal cord or nerves branching off the spinal cord. The bone typically becomes more unstable. Imagine an oreo cookie being smashed at the top, causing it to break into many different fragments. Depending on the stability of the fracture which is identified via imaging (x-ray, CT, and MRI), this may require surgery.

Chance Fracture

This fracture is known as a “seat-belt injury” and is caused by a violent forward flexed injury.  The vertebra is pulled apart, often from a car accident where the upper body is pulled forward while the pelvis is stabilized by a lap-only seat belt. They usually occur in the lower mid-back region. Most of the time these fractures require surgery due to significant pain and need to be stabilized.

Risk Factors

There are several risk factors that could make it more likely for you to develop the condition. Some of the most common examples include:

  • If you are involved in an injury that involves a high velocity mechanism- in a motor vehicle, slip or fall, not being restrained or wearing proper safety gear. 
  • Having osteoporosis means the bones are weak and a strong impact could cause injury to the bones.
  • Also, having an uncommon condition called ankylosing spondylitis, can also put patients at risk for dislocation. This is an inflammatory condition that causes the spine to become stiff and brittle so a low impact injury can cause spinal fracture. 
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solutions being pipetted into various test tubes

Diagnosing Spinal Fractures

Vertebral fractures are diagnosed by an x-ray in the respective location of the spine – neck, mid back or low back. Following the x-ray your spinal specialist will generally order a CT scan which is an effective way to visualize any changes in the bony structure. A MRI may also be ordered to evaluate the surrounding soft tissues, ligaments, intervertebral discs, or to identify any spinal cord injury.

Treatment Options

Treatment will depend on the location and type of fracture as well as other 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. For patients with neurologic compromise or unstable fractures, surgical intervention may be appropriate in order to stabilize the fracture, remove any nerve compression and assist with healing. For most patients, non-surgical treatment is appropriate. Rehabilitation is an essential part of the treatment plan once the injury has healed. Rehabilitation allows patients to reduce pain and minimize disability with a hopeful return to their functional level before the injury.  

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Frequently Asked Questions about Spinal Fractures

Generally, for a vertebral/spine fracture, we would like the patient to avoid any heavy physical activity for 12 weeks to allow the body to heal on its own with the help of bracing. During the first 12 weeks, we carefully monitor the patient and do serial x-rays to watch for any changes in the fracture. 

For most broken bones, pain is generally worse during the first few weeks after initial injury. A combination of muscle relaxers, pain medication, Tylenol, or bracing may be used to help control symptoms. Following this initial period, patients generally notice a significant improvement in symptoms.

For most spinal fractures surgery is not needed and many respond well to conservative therapies such as bracing or rehabilitation. However, for some, surgical intervention is needed especially if the fracture is unstable. If there is evidence of spinal cord irritation, compression or injury surgery may be warranted.

Yes, with certain fractures that are stable the patients may be a candidate for minimally invasive procedures such as kypholasty or vertebroplasty. However, with any spinal fracture this should be fully evaluated by your spinal specialist to understand which treatment options are available and safest for you.

If you have persistent pain, severe pain, or any extremity symptoms, you should be evaluated. At least an xray can be helpful to determine the spine anatomy and if further imaging is warranted.

It is important to see a spinal specialist to help you determine what your options are. The type of fracture, your symptoms, and the nerve or spinal cord involvement are factors that need to be considered what treatment is going to give the best recovery and outcome.

It is always important to identify and recognize when you have pain that comes out of nowhere. It cannot be ignored. This can be a sign of a disc herniation or a spinal tumor.

Seeing a spinal specialist that knows how to treat the spine is more ideal than going to a general orthopedic. If you continue to have pain, you want to know what other options there are for treatment besides time and physical therapy.

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