Spinal fractures are different than a broken arm or leg. A fracture or dislocation of a vertebra can cause bone fragments to pinch and damage the spinal nerves or spinal cord. Most spinal fractures occur from car accidents, falls, gunshot, or sports. Injuries can range from relatively mild ligament and muscle strains to fractures and dislocations of the bony vertebrae to debilitating spinal cord damage. Depending on how severe your injury is, you may experience pain, difficulty walking, or be unable to move your arms or legs (paralysis). Many fractures heal with conservative treatment; however, severe fractures may require surgery to realign the bones.
Spinal injuries can range from relatively mild ligament and muscle strains (such as whiplash) to fractures and dislocations of the bony vertebrae 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 cervical (neck) region. Sixty-four percent occur in the thoracolumbar (low back) region, often at T12-L1.
There are numerous classifications for fractures. In general, spine fractures fall into three categories:
Symptoms of a spinal fracture 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 is the spinal cord completely severed.
Spinal stenosis in the cervical spine may result in pressure on the nerves causing pain to the upper extremities, or it may result in pressure on the spinal cord resulting in possible spinal damage. Symptoms of this spinal damage may be pain in the neck as well as difficulty in controlling the arms and legs, numbness through the body, bowel and bladder difficulties, and increased reflexes (jumpy legs) in the lower extremities.
Car accidents (45%), falls (20%), sports (15%), acts of violence (15%), and miscellaneous activities (5%) are the primary causes of spinal fractures. Diseases such as osteoporosis and spine tumors also contribute to fractures.
In most cases of a spinal injury, paramedics will take you to an emergency room (ER). The first doctor to see you in the ER is an Emergency Medicine specialist who is a member of the trauma team. Depending on your injuries, other specialists will be called to assess your condition. The doctors will assess your breathing and perform a physical exam of the spine. The spine is kept in a neck or back brace until appropriate diagnostic tests are completed.
X-ray test uses x-rays to view the bony vertebrae in your spine and can tell your doctor if any of them show fractures. Special flexion and extension x-rays may be taken to detect any abnormal movement.
Computed Tomography (CT) scan is a safe, noninvasive test that uses an X-ray beam and a computer to make 2-dimensional images of your spine. It may or may not be performed with a dye (contrast agent) injected into your bloodstream. It is especially useful for viewing changes in bony structures.
Magnetic Resonance Imaging (MRI) scan is a noninvasive test that uses a magnetic field and radiofrequency waves to give a detailed view of the soft tissues of your spine. Unlike an X-ray, nerves and discs are clearly visible. It may or may not be performed with a dye (contrast agent) injected into your bloodstream. MRI is useful in evaluating soft tissue damage to the ligaments and discs and assessing spinal cord injury.
Treatment of a fracture 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 & Orthotics do three things, 1) maintains spinal alignment; 2) immobilizes your spine during healing; and 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 & 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 & 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.