Spinal fractures
Overview
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 column and spinal cord
To understand spinal fractures,
it is helpful to understand how your spine works
(see Anatomy of the
Spine). Your spine is made of 33 bones called
vertebrae that provide the main support for
your body, allowing you to stand upright, bend,
and twist. In the middle of each vertebra is
a hollow space called the spinal canal, which
provides a protective space for the spinal cord
(Fig. 1). The spinal cord serves as an information
super-highway, relaying messages between the
brain and the body. Spinal nerves branch off
the spinal cord, pass between the vertebrae,
to innervate all parts of your body.
Figure 1. Vertebrae have 3 main parts. The body (purple) is a weight-bearing surface and an attachment for the disc. The vertebral arch (teal) forms the spinal canal through
which the spinal cord runs. The processes (beige) arise
from the vertebral arch to form the facet joints
and processes for muscle and ligament attachments.
What are spinal fractures?
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.
Whiplash
Whiplash is a common injury to the neck
caused by hyperextension or rapid back and
forth motion of the head - most often in
a car accident. The jerking motion strains
the muscles and ligaments of the neck and
may cause the discs to bulge. Whiplash can
lead to headaches, stiff muscles, or neck
pain. It is important that a doctor examine
a spine injury carefully. Whiplash is different
than a spinal fracture or spinal cord injury
and the symptoms usually improve with conservative
treatment. |
Spinal
instability
Spinal instability is the excessive motion
between vertebrae caused by stretched or
torn ligaments and broken bone. Abnormal
slipping and rubbing motions can cause pain
and damage the spinal nerves or spinal cord.
Stable fractures can usually be treated
with bracing and rest. Unstable fractures
usually require surgery to realign the bones
and prevent spinal cord or nerve injury. |
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:
Fractures: when more pressure
is put on a bone than it can stand, it will
break. The most common type of spine fracture
is a vertebral body compression fracture (Fig.
2). Sudden downward force shatters and collapses
the body of the vertebrae. If the force is great
enough, it may send bone fragments into the
spinal canal, called a burst fracture.
Figure 2. (Left) Normal spine. In a compression fracture (right), sudden downward
force shatters the body of the vertebra (arrow).
People affected by osteoporosis, tumors,
and certain forms of cancer that weaken bone
are prone to vertebral compression fractures
(VCF). The fracture appears as a wedge-shaped
collapse of the vertebra. Multiple VCFs can
cause a forward hunch of the spine called
kyphosis.
Dislocations: when the
ligaments and/or discs connecting two vertebrae
together are stretched or torn, the bones may
come out of alignment (Fig. 3). For example,
when the rapid forward motion of the upper body
against a seat belt pulls apart the vertebra
and stretches the ligaments. A dislocated vertebra
can cause instability and spinal cord compression.
They usually require stabilization surgery or
a brace.
Figure 3.
In a dislocation, the ligaments are stretched
or torn (arrows) allowing the vertebra to come
out of alignment.
Fracture-dislocations:
occur when bone is broken and the ligaments
are torn (Fig. 4). These fractures are usually
unstable, tend to be very debilitating, and
are often surgically repaired.
Figure 4.
In a fracture-dislocation, both the bone and
ligaments are disrupted (arrows).
What are the symptoms?
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.
What are
the causes?
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.
Who
is affected?
- 80% of patients are aged 18-25 years
- Men are 4 times more likely to have a traumatic
spinal fracture than women
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.
Clinical trials
Clinical trials are research studies in which new
treatments - drugs, diagnostics, procedures,
vaccines, and other therapies - are tested in people
to see if they are safe and effective. You can find
information about current clinical investigations,
including their eligibility, protocol, and participating
locations, on the web at: the National Institutes of
Health (NIH) at Clinicaltrials.gov and Centerwatch.com.
Sources
& links
If you have more questions, please contact Mayfield Brain & Spine at 800-325-7787 or 513-221-1100.
Links
Spineuniverse.com
Spine-health.com
Glossary
bone graft: bone harvested
from ones self (autograft) or from another (allograft)
for the purpose of fusing or repairing a defect.
fusion: to join together
two separate bones into one to provide stability.
kyphoplasty: a minimally
invasive procedure used to treat vertebral compression
fractures by inflating a balloon to restore
bone height then injecting bone cement into
the vertebral body.
spinal cord: part of the
central nervous system enclosed and protected
by the spinal vertebrae; conducts messages,
or impulses, back and forth between your brain
and body to control sensation and movement.
spinal instability: abnormal
movement between two vertebrae that can cause
pain or damage the spinal cord and nerves.
vertebral compression fracture (VCF): a break in the vertebral body of the
spine causing it to collapse and produce a wedge-shaped
deformity.
vertebroplasty: a minimally
invasive procedure used to treat vertebral compression
fractures by injecting bone cement into the
vertebral body.
whiplash: an injury to
the ligaments and muscles of the neck resulting
from rapid acceleration or deceleration (as
in an auto accident).
updated > 9.2018
reviewed by > Michael Kachmann, MD, Mayfield Clinic, Cincinnati, Ohio
Mayfield Certified Health Info materials are written and developed by the Mayfield Clinic. This information is not intended to replace the medical advice of your health care provider.
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