Spinal Fractures

 

Spinal Fractures

 

Although not as common as mechanical causes of back pain such as facet syndrome or a bulging disc, spinal fractures can be a serious cause of back pain. There are several different kinds of spinal fractures, and unlike a broken leg or arm, spinal fractures have the potential to cause other  problems due to the fact that they can also cause damage to the spinal cord or nerves. This can result in a serious problem presenting with other symptoms due to nerve injury.

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).

 

 

 

 

 

 

 

 

 

 

 

 

Typical Spinal Fracture Symptoms

The main clinical symptoms of vertebral fractures typically include one or a combination of the following symptoms:

  • Sudden onset of back pain
  • Standing or walking will usually make the pain worse
  • Lying on one’s back makes the pain less intense
  • Limited spinal mobility
  • Height loss
  • Deformity and disability

The symptoms of a spinal fracture vary depending on the severity of the fracture, and it’s location. Symptoms may also include back or neck pain, numbness, tingling, muscle spasm, weakness, bowel/bladder changes, and even paralysis. Paralysis is a loss of the ability to move the arms or legs, and may indicate a spinal cord injury. However, it is important to know that not all fractures cause spinal cord injury/damage.

 

What Are The Causes Of Spinal Fractures? 

Car accidents (45{95f364b8aea3ba4afb976a81c1dcc2e8147daac1866ef443968911255633a999}), falls (20{95f364b8aea3ba4afb976a81c1dcc2e8147daac1866ef443968911255633a999}), sports (15{95f364b8aea3ba4afb976a81c1dcc2e8147daac1866ef443968911255633a999}), acts of violence (15{95f364b8aea3ba4afb976a81c1dcc2e8147daac1866ef443968911255633a999}), and miscellaneous activities (5{95f364b8aea3ba4afb976a81c1dcc2e8147daac1866ef443968911255633a999}) are the primary causes of spinal fractures. Diseases such as osteoporosis and spine tumors also contribute to fractures.

 

Who Is Affected By Traumatic Spinal Fractures?

80{95f364b8aea3ba4afb976a81c1dcc2e8147daac1866ef443968911255633a999} of patients are aged 18-25 years.
Men are 4 times more likely to have a traumatic spinal fracture than women.

 

Types Of Spinal Fractures.

There are several different types of spinal fractures: Compression, Burst, Flexion-distraction, and Fracture-dislocation. Each of these types of fractures is described below. Other terms used to describe a spinal fracture include stable, unstable, minor, and/or major.

Compression Fracture: This type of fracture is very common in patients with osteoporosis, or patients whose bones have been weakened by other diseases (such as bone cancer). Each spinal vertebra can only absorb so much pressure. If there is a sudden force involving a lot of pressure on the vertebra, it may not be able to handle the stress and will collapse and fracture.
A wedge fracture is a subtype of compression fracture. With a wedge fracture, part of the vertebra—usually the anterior (front) part—collapses under pressure causing the vertebra to become wedge shaped.

Burst Fracture: Burst fractures are caused by a severe trauma, for example a car accident. They can happen when the vertebra is essentially crushed by sudden, extreme force. Unlike compression fractures, it’s not just one part of the vertebra that’s fractured. In a burst fracture, the vertebra is fractured in multiple places. Because the vertebra is crushed completely, bony fragments can spread out and cause spinal cord injury. Burst fractures are more severe than compression fractures.

Flexion-distraction Fractures: If you’re in a car accident where your body is pushed forward, you may get a flexion-distraction fracture. Your spine is made to flex forward, but if there’s a sudden, excessive forward movement that places incredible stress on the spine into flexion, it may break a vertebra or vertebrae. 

Fracture-dislocation: If you have any of the above fractures and the vertebra(e) moves significantly (dislocation), you have a fracture-dislocation. They can make your spine very unstable.

Fracture of the Transverse Process: Fractures of the transverse processes of the lumbar spine are considered relatively common with blunt force trauma associated with contact sports and motor vehicle accidents (MVA).  Transverse process fractures may also arise as a result of avulsion (the bone being broken and pulled off by the muscle) from forceful muscle contractions involving the quadratus lumborum or psoas major muscles. In the absence of abdominal trauma and when the fracture is non-displaced, transverse process fractures are considered benign with a return to normal activities after 4 to 6 weeks.

The risk of internal organ damage is high in cases where the mechanism of onset is MVA, although these complications are usually found in cases with multiple fractures involving the pelvis and the ribcage. 

 

Stable and Unstable Fractures

Stable fractures don’t cause spinal deformity or neurologic (nerve) problems. With a stable fracture, the spine can still carry and distribute your weight pretty well (not as well as if there weren’t a fracture, but it’s still able to function with a stable fracture).
Unstable fractures make it difficult for the spine to carry and distribute weight. Unstable fractures have a chance of progressing and causing further damage. They may also cause spinal deformity.

Major and Minor Fractures

Minor fracture means a part of the posterior (back side) elements of the vertebra has broken—parts of the spine that are not as important to spinal column stability, or stability at the fractured level. The posterior elements include the spinous process and the facet joints (also called the articular processes). If you fracture this part of the vertebrae, it’s usually not too serious.
Major fracture means that part of the vertebral body, the pedicles, or the lamina has fractured. Fracturing the vertebral body is considered major because it helps carry so much weight and distribute the force of your movements. If it’s broken, you can have serious problems with the vertebrae lining up correctly. Fracturing the pedicles or lamina is dangerous because of the increased possibility of nerve damage. Additionally, the pedicles and lamina provide a lot of necessary support to keep your spine stable. If they fracture, your spine may be unstable.

 

Spinal Fracture Risk Factors

Aside from partaking in risky activities or extreme sports, the biggest risk factor for spinal fracture is due to a decrease in bone density. If your bones are slowly becoming weaker, possibly due to osteoporosis or osteopenia, it is not something that you notice or feel. Unfortunately for most people, the first indication that they are losing bone density is from a spinal compression fracture. The following list indicates several risk factors for spinal fracture.

Aging: As we age, our bones naturally lose some density and become weaker, so the risk for fractures increases.
Being female: Bone loss is more common in women, especially post-menopausal women. Women lose bone mass at an accelerated rate in the first 5-7 years after menopause. During menopause, women experience a steep drop in estrogen, which is a female sex hormone that protects bones. When estrogen levels decrease, bones may lose density and become prone to fractures.
Having a pre-existing spinal fracture: It sounds obvious, but having one spinal fracture greatly increases your chances of having another. Over time, multiple fractures can cause a loss of height, and you may notice your spine starting to hunch forward. Your doctor may refer to this forward curve as a condition called kyphosis.
Unhealthy lifestyle habits: Smoking, drinking large amounts of alcohol, and not exercising can all affect healthy bone density. Smoking and heavy alcohol consumption affects your body’s ability to absorb calcium. Living a sedentary lifestyle makes bones weak, making them prone to bone loss.

 

How is a diagnosis made?

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.

 

What treatments are available?

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.

 

 

 

Vertebral fractures can be a serious health problem, particularly if the spinal cord or internal organs are damaged/injured. Usually the sudden onset of pain is a strong indication for the possibility of spinal fracture, and professional medical help should be a priority.

If you have any questions, or would like to share your own experience, please leave us a comment below.

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