Spinal Fractures

What is a Spinal Fracture?

A Spinal fracture, also known as a vertebral fracture, refers to any fracture or dislocation of a vertebra that results in bone fragments which can pinch and damage the spinal nerves or spinal cord ¹. This mainly occurs from heavy impact-injuries like car accidents, falls, gunshot, or sports impacts.

The spinal fracture can escalate into a serious medical condition because of high-energy trauma and often requires emergency treatment. Most of the spinal fractures occur in the thoracic and lumbar spine, or at the junction between these two regions ².

What are the main causes and risk-factors for a Spinal Fracture?

Fracture of the thoracic and lumbar spine results from high-energy trauma, such as a:

• Car accident or motorcycle collision (45%)
• Fall from a significant height (20%)
• Sports accident (15%)
• Violent act, such as a gunshot wound (15%)
• Miscellaneous activities (5%)

Some diseases such as osteoporosis, osteosarcoma, osteochondroma, and spine tumors may aggravate the factors responsible for the fracture. The prevalence of spinal fracture in men results in four times higher than the woman. A recent study shows that about 80% of spinal fractures occur between the age of 18 to 25 years ³.

Types of Spinal Fracture

The different types of spinal fractures vary according to their cause, severity, and location. These include:

1. Compression Fracture: This fracture mostly occurs in patients with osteoporosis, or patients with weak vertebrae because of diseases like bone cancer. In the USA, about 70,000 spinal fractures attributed to osteoporosis every year ⁴.
2. Burst Fracture: A burst fracture typically occurs from severe trauma, such as a car accident or fall from a height that results in a complete crush of the vertebral body. In this condition, a vertebra may completely crush by high energy axial load onto the spine. Unlike compression fractures, this involves a fracture in multiple locations.
3. Flexion-distraction Fractures: Spinal flexion-distraction injuries occur because of the distractive forces causing disruption of the middle and posterior spinal columns. This fracture proceeds ventrally from the spinous process through the vertebral body ³.
4. Fracture-dislocation: If you have any of the above fractures that involve the moving of vertebra in a significant margin means dislocation, then you have a fracture-dislocation. This fracture makes the spine very unstable ⁵.

Symptoms of Spinal Fracture

Symptoms of spinal fractures vary according to the severity and location of the injury, whatever it is, thoracic, or lumbar region. They include:

• Severe pain in the back or neck region
• Pain radiates towards the arms or legs
• Muscle spasm
• Bowel or bladder changes
• Loss of height
• Deformity and disability
• Difficult walking or standing
• Numbness, weakness, and tingling of the arms or legs
• Paralysis (if spinal cord injured)

How do neurosurgeons diagnose a Spinal Fracture?

The initial diagnosis includes a physical examination to document the spinal deformity of patients, and neurologic examination to test muscle strength and sensation ⁶. Doctors may further confirm by:

• X-ray;
• Computed tomography (CT) scan; and
• Magnetic resonance imaging (MRI);

What is the treatment for a Spinal Fracture?

The major treatment protocols for patients with spinal fractures are conservative pain management and stabilization to prevent further injury. Depending on the condition of fracture and its stability, surgery or bracing may be necessary. These include:

1. Pain Management: Medications like nonsteroidal anti-inflammatory drugs, calcitonin, and bisphosphonates, remains the first-line therapy for patients.
2. Braces & Orthotics: This maintains spinal alignment, immobilizes your spine during healing, and controls pain by restricting movement.
3. Fusion & Instrumentation: These surgical procedures used to treat unstable fractures. Fusion means the joining of two vertebrae with a bone graft held together with hardware such as plates, rods, screws, or hooks. This takes several months to recover.
4. Vertebroplasty & Kyphoplasty: These techniques performed to treat compression fractures commonly caused by osteoporosis and spinal tumors. In vertebroplasty, doctors inject bone cement through a hollow needle into the fractured vertebral body. In kyphoplasty, doctors insert a balloon first to expand the compressed vertebra before filling the space with bone cement.
5. Vertebral Augmentation: As a new procedure, this helps to reduce pain and improve the quality of life.

References

1. El-Faramawy A, El-Menyar A, Zarour A, Maull K, Riebe J, Kumar K, Mathew J, Parchani A, Al-Thani H, Latifi R. Presentation and outcome of traumatic spinal fractures. Journal of Emergencies, Trauma and Shock. 2012;5(4):316–320. doi:10.4103/0974-2700.102381
2. Rajasekaran S, Kanna RM, Shetty AP. Management of thoracolumbar spine trauma An overview. Indian Journal of Orthopaedics. 2015;49(1):72–82. doi:10.4103/0019-5413.143914
3. Grossbach AJ, Dahdaleh NS, Abel TJ, Woods GD, Dlouhy BJ, Hitchon PW. Flexion-distraction injuries of the thoracolumbar spine: Open fusion versus percutaneous pedicle screw fixation. Neurosurgical Focus. 2013;35(2):1–6. doi:10.3171/2013.6.FOCUS13176
4. Genev IK, Tobin MK, Saher Ã, Zaidi P, Khan SR, Amirouche FML, Mehta AI. Spinal Compression Fracture Management: A Review of Current Treatment Strategies and Possible Future Avenues. Global Spine Journal. 2017;7:71–82. file:///C:/Users/niamh/Downloads/Spinal Compression Fracture Management_ A Review of Current Treatment Strategies and Possible Future Avenues.pdf. doi:10.1055/s-0036-1583288
5. Kupczik F, Schiavon MEG, Vieira L de A, Tenius DP, Fávaro RC. Knee Dislocation: Descriptive Study of Injuries. Revista Brasileira de Ortopedia (English Edition). 2013;48(2):145–151. doi:10.1016/j.rboe.2012.10.002
6. Epstein N, Baisden J. The diagnosis and management of synovial cysts: Efficacy of surgery versus cyst aspiration. Surgical Neurology International. 2012;3(4):157. doi:10.4103/2152-7806.98576