Fractures of the Spine

Fractures of the vertebral column commonly result from motor vehicle accidents, a fall from a height, gunshot injuries, or sports injuries. The compression fractures of the vertebra commonly result in trivial falls in the elderly population as a result of osteoporosis. The fractures of the spine may sometimes be managed with conservative treatment such as bracing but occasionally may require operative management.

CT scan of the thoracic spine showing a burst fracture of the T6 vertebra.

The vertebral column consists of vertebra stacked on each other providing a safe conduit for the spinal cord. The spinal cord transmits signals from the brain that help in the movement of the four limbs. The spinal cord also gives branches known as spinal nerves at each level that travel to the part they supply.

The symptoms of spine fractures depend upon the nature of fracture and the inciting event leading to fracture. The spine fractures resulting from high-intensity injuries such as fall from height or motor vehicle accident usually involve injuries to other organs/body-parts as well. On the other hand, osteoporotic compression fractures are usually asymptomatic for a period of time. 

Commonly the mid-back or the lower back is involved in spine fractures and the symptoms depend upon the part of the segment fractured. The fractures of the mid and the lower back may be potentially dangerous due to the narrow spinal canal. The blood supply of the spine is also precarious in the thoracolumbar area and the area acts as a fulcrum of motion of the spine.

In cases where only the front of the vertebra gets fractured and the back of the vertebrae is intact, it is known as the flexion type of spine fracture. These fractures usually do not result in loss of neurological function and are considered stable fractures.

Usually, as a result of fall from a height, both the front and the back of the vertebral body lose height. These types of fractures are known as burst fractures and may be associated with neurological injuries.

Extension fractures typically occur as a result of motor vehicle accidents where the pelvis is stabilized by the car seatbelt and the upper spine moves forward. The extension fractures may lead to instability of the spine and neurological injury.

Fracture dislocation injuries involve a fracture of a part of the vertebrae with damage to the soft tissue structures required for stabilizing the spine. These injuries may lead to serious damage to the spinal cord.

Whiplash injuries are common in the neck due to excessive forward and backward motion of the spine in a motor vehicle accident. The various ligaments and muscles attached to the vertebral column may be torn or strained to lead to instability. There may be bulging of intervertebral disks leading to spinal cord compression.

The symptoms of spinal fractures depend upon the level involved. There is severe pain in the spine which gets worse on movement. The involvement of the spinal cord or spinal nerves may lead to weakness and numbness in the legs in the case of thoracic and lumbar involvement. There may be a loss of bowel and bladder control.

In the case where the spine fracture is sustained because of trauma, the patients need emergency management. Once the patients are stabilized at the hospital, a thorough evaluation of their injuries is made. The physician tests for the neurological integrity in the patient and any signs suggesting neurological damage.

Radiological tests are done which include X-rays, CT scans, and MRI. The radiological studies help determine the nature of fracture and the degree of spinal cord damage. The radiological studies also help in planning surgical management if needed.

The treatment depends upon the type of fracture, the segment involved, other injuries and their treatment, and the presence or absence of neurological injury. Flexion type injuries or stable fractures are generally treated with bracing of the spine for 2-3 months and physical rehabilitation once the fracture unites.

In cases of spinal instability or neurological damage, surgical management is usually done in the form of laminectomy with spine stabilization. The stabilization is usually done in the form of fusion with screws and rods in the adjacent vertebrae. In compression fractures of the spine resulting from osteoporosis, kyphoplasty or vertebroplasty may be done.

The ultimate goal of surgery is to relieve the pressure on the spinal cord and stabilize the segment involved. The surgery may be performed from the front, from the sides, or from the back.

As with any surgery, there may be a risk of complications in the form of bleeding, infection, instrument failure, blood clots, spinal fluid leakage, non-union of the fracture, etc. The spine surgeries are followed by a period of extensive rehabilitation and the ultimate return to previous activity depends upon the initial spine damage.