Spinal Fracture

Types of Spinal Fractures

Spinal fractures can be categorized based on their location, mechanism of injury, and the extent of damage. Common types of spinal fractures include:

1. Compression Fractures

• Definition: A compression fracture occurs when one or more vertebrae are compressed or crushed, typically due to a fall or high-impact trauma. The vertebrae become “squashed,” resulting in a decrease in height. This is more common in the thoracic or lumbar spine and often affects older adults with weakened bones due to osteoporosis.
• Symptoms: Sudden back pain, especially with movement, and possible deformity (such as a hunched back, known as kyphosis).
• Cause: Can result from osteoporosis, trauma, or lifting heavy objects improperly.

2. Burst Fractures

• Definition: A burst fracture occurs when a vertebra breaks into several pieces due to a high-energy impact. This type of fracture can be more severe, often leading to damage to the spinal cord or nerves.
• Symptoms: Severe back pain, nerve pain, numbness, or tingling if the spinal cord or nerves are compressed.
• Cause: Usually caused by high-impact trauma, such as a car accident, fall from a great height, or sports injury.

3. Fracture-Dislocations

• Definition: A fracture-dislocation occurs when a vertebra is both fractured and dislocated, often involving the facet joints that link adjacent vertebrae. This type of injury is typically more severe because the spinal canal is often compromised, which can lead to spinal cord injury or nerve damage.
• Symptoms: Severe pain, loss of mobility, numbness or weakness in the limbs, and, in severe cases, paralysis or loss of bladder or bowel control.
• Cause: High-energy trauma, such as a car accident, violent sports injury, or a fall from a significant height.

4. Flexion-Distraction Fractures

• Definition: This injury occurs when the spine is forced to bend or “hyperflex” beyond its normal range, often leading to fractures in the posterior (back) part of the vertebrae or the intervertebral discs. These fractures typically affect the lumbar spine.
• Symptoms: Intense back pain, particularly when moving or bending, and possible nerve involvement with weakness or numbness in the legs.
• Cause: High-impact trauma, often associated with seatbelt injuries in car accidents.

5. Chance Fractures

• Definition: Chance fractures occur due to hyperflexion (bending forward) of the spine, typically resulting in fractures of the vertebral body and posterior elements (the spinous process, lamina, and facet joints). They often occur in the lumbar spine and are commonly seen in motor vehicle accidents.
• Symptoms: Acute pain in the back, potential injury to the spinal cord or nerves leading to weakness, numbness, or loss of function in the limbs.
• Cause: High-impact accidents, especially those that involve sudden deceleration, such as a car crash where the seatbelt applies force to the upper body.

Causes of Spinal Fractures

Spinal fractures can occur as a result of both trauma and degenerative conditions:

1. Trauma

• Motor vehicle accidents: High-speed impacts or seatbelt injuries.
• Falls: Especially common in older adults, who may experience fractures due to weakened bones.
• Sports injuries: Particularly in contact sports such as football, rugby, or diving accidents.
• Workplace accidents: Heavy lifting or sudden movements that put excess strain on the spine.

2. Degenerative Conditions

• Osteoporosis: A condition where bones become brittle and fragile, increasing the risk of fractures from minor trauma or even normal activity.
• Spinal tumors: Bone cancer or metastasis to the spine can weaken the vertebrae and make them more prone to fracture.
• Paget’s disease: A disorder that causes abnormal bone growth and may lead to spinal fractures.
• Spinal infections: Infections such as osteomyelitis or discitis can weaken the vertebrae, making them susceptible to fractures.

Symptoms of Spinal Fractures

The symptoms of a spinal fracture vary depending on the location, type, and severity of the injury. Common signs include:

1. Back Pain:
   • Often the first and most prominent symptom, which can range from mild to severe, depending on the injury.
   • Pain may be localized or radiate to other areas, such as the legs or neck.
2. Nerve Symptoms:
   • Numbness or tingling (parathesias) in the arms, legs, or other parts of the body.
   • Weakness or difficulty moving limbs, which could indicate nerve involvement or damage to the spinal cord.
   • Loss of coordination or difficulty walking.
   • Bladder or bowel dysfunction: Loss of control over bladder or bowel function can occur if the spinal cord is damaged.
3. Deformity:
   • Visible deformity, such as a hunched back (kyphosis), especially in compression fractures.
   • Abnormal spinal curvature.
4. Shock or Unconsciousness:
   • Severe trauma may lead to shock or loss of consciousness, especially if the spinal cord is injured.

Diagnosis of Spinal Fractures

A spinal fracture is typically diagnosed through a combination of medical history, physical examination, and imaging tests. Common diagnostic steps include:

1. Medical History:
   • The doctor will ask about the circumstances of the injury (e.g., trauma, fall) and any symptoms, such as pain, weakness, or numbness.
2. Physical Examination:
   • A physical exam will assess range of motion, neurological function, and the presence of any deformities or tenderness along the spine.
3. Imaging Studies:
   • X-rays: Standard initial imaging to look for visible fractures or dislocations.
   • MRI (Magnetic Resonance Imaging): MRI is the best method for evaluating soft tissues, including the spinal cord and nerves. It can help identify spinal cord damage, disc herniations, or nerve impingement.
   • CT scan (Computed Tomography): A CT scan can provide detailed images of the bones and is helpful for identifying complex fractures, such as burst fractures or fractures involving the spinal cord.
   • Bone scans: May be used to evaluate for stress fractures or fractures caused by tumors or infections.
4. Neurological Tests:
   • If there is concern about nerve damage or spinal cord injury, tests such as electromyography (EMG) or nerve conduction studies may be used to assess nerve function.

Treatment of Spinal Fractures

The treatment for a spinal fracture depends on the type, location, severity, and whether the spinal cord or nerves have been affected.

1. Conservative Treatment:

• Rest and Activity Modification: In less severe fractures, especially compression fractures, rest and limiting activities may be sufficient. Braces or corsets are often used to stabilize the spine and reduce movement.
• Pain Management: Nonsteroidal anti-inflammatory drugs (NSAIDs), acetaminophen, or stronger pain medications (opioids) may be used to control pain.
• Physical Therapy: After the initial healing period, physical therapy can help strengthen the muscles around the spine and improve flexibility.

2. Surgical Treatment:

• Spinal Fusion: In more severe cases or fractures involving instability, surgery may be required to stabilize the spine. This involves joining (fusing) two or more vertebrae using bone grafts and screws/rods.
• Vertebroplasty or Kyphoplasty: These minimally invasive procedures are often used to treat compression fractures caused by osteoporosis. In vertebroplasty, bone cement is injected into the fractured vertebra to stabilize it. In kyphoplasty, a balloon is used to inflate the fractured vertebra before injecting cement.
• Decompression Surgery: If the fracture compresses the spinal cord or nerves, surgery may be performed to relieve the pressure.

3. Rehabilitation:

• After treatment, rehabilitation through physical therapy is crucial to improve strength, flexibility, and function. It may include exercises to help restore movement, improve posture, and prevent further injury.

Complications of Spinal Fractures

Spinal fractures, especially those that involve the spinal cord or nerves, can lead to complications:

1. Spinal Cord Injury: Fractures that damage the spinal cord can lead to paralysis, loss of sensation, or bladder and bowel dysfunction. The severity depends on the location of the injury (e.g., cervical injuries may cause tetraplegia, while lumbar injuries may cause paraplegia).
2. Chronic Pain: Persistent back pain or nerve-related pain can result from a spinal fracture, especially if the fracture causes nerve compression.
3. Spinal Deformities: A severe compression fracture can cause kyphosis (hunched back) or other deformities that may require surgical intervention.
4. Infection: If surgery is required, there is a risk of infection, especially around the surgical site.

Prognosis

The prognosis of a spinal fracture depends on factors such as the type of fracture, the location of the injury, the presence of neurological damage, and the overall health of the patient.

• Mild fractures (e.g., compression fractures due to osteoporosis) often heal well with conservative treatment.
• Severe fractures or those involving spinal cord damage can lead to significant disability, with recovery varying depending on the severity of the injury and the effectiveness of treatment.