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.
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. All patients with trauma who develop cervical fractures should be evaluated in an emergency room setting. 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 of spinal fractures 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.
Spinal fractures 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 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, part remains stable. The shape of the vertebrae is usually described as a “wedge”. It can be painful or asymptomatic and is usually a stable fracture.
Axial Burst Fracture: This is usually caused from a fall from a significant height, landing on the feet. The vertebra loses height on both the front and back side, causing a decrease in 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. 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.
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.
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 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 for spinal fractures 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 to the treatment plan once the spinal fracture has healed. Rehabilitation allows patients to reduce pain and minimize disability with a hopeful return to their functional level before the injury.
Reviewed by: Dr. Christopher Good, MD, FACS.