A spinal fracture also called a vertebral fracture or a broken back, is a fracture affecting the vertebrae of the spinal column. Types of spinal fracture include vertebral compression fracture and burst fracture, cervical fracture, Jefferson fracture, Hangman's fracture, Flexion teardrop fracture, Clay-shoveler fracture, Chance fracture andHoldsworth fracture. Vertebral fractures of the thoracic vertebrae and lumbar vertebrae are usually associated with major trauma and can cause spinal cord damage that results in a neurological deficit.
Spinal fractures occur when the bones of the spine, called vertebrae break and collapse. They can happen due to trauma or injury, such as experiencing a severe fall or car accident, due to conditions such as osteoporosis (a condition which weakens the bones) or cancer. Spinal fractures are the leading cause of morbidity and mortality in the aging population worldwide. Identifying spinal fractures are necessary because they are predictors of future fracture. Most vertebral fractures do not come to clinical attention. The prevalence of spinal fractures increases with age in both men and women.
Primary causes of spinal fractures
Spinal fractures can be caused by number of reasons with the most common causes listed below.
- Car accidents (45%)
- Falls (20%)
- Sports (15%)
- Acts of violence (15%)
- Miscellaneous activities (5%)
- Diseases: osteoporosis and spine tumors also contribute to fractures.
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Risk factors
Following risk factors increase the chance of a person suffering from a spinal fracture.
- Old age
- Previous fractures
- Low body mass index
- Smoking
- Low calcium intake
- Sedentary life style
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Signs and Symptoms
Symptoms of spinal fractures can include pain or the development of neural deficits such as:
- Weakness
- Tingling
- Numbness
- Neurogenic shock – In this, as a result of autonomic hyporeflexia hypotension is associated with relative Slow Heart Rate (bradycardia).
- Spinal shock – in this, short-term loss of spinal reflex activity that occurs below a partial or complete spinal cord injury
- if the injury to thoracic or lumbosacral cord leads to neural deficits at the trunk, genital area, and lower extremities.
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Diagnosis of Spinal Fractures
CT scans
CT scans can readily detect bone fractures and help with the assessment of the extent of fractures
MRI (magnetic resonance imaging)
This is usually the study of choice for determining the extent of damage to the spinal cord; and also to detect lesions of neural tissue and bone
X-ray
x-ray helpful in screening for fractures, but hairline fractures or non-displaced fractures may be difficult to detect
Serum calcium levels
In patients with metastatic disease (cancer) to the bone and resultant pathologic fractures, a serum calcium determination is necessary; to rule out hypercalcemia that requires medical attention.
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Treatment
Non-Surgical Treatment
Minor fractures are treated without the surgery. Non-operative management of unstable spinal fractures involves physiotherapy to relieve pain and the use of spinal orthotic braces to prevent rotational movement and to bend.
Physiotherapy Management
Physiotherapy is beneficial to patients recovering from the acute vertebral fracture to reduce pain and improve mobility. The use of pain reducing techniques in the acute phase after vertebral fracture is beneficial—ultrasound, ice, heat, hydrotherapy, early mobilization, stretching exercises to decrease muscle spasm, and to improve spinal stability. Evidence that muscle strengthening, gait training or flexibility exercises can reduce the risk of spinal fractures and improve spinal mobility. Spinal extension rather than flexion exercises may lead to better pain relief and decrease the pressure on your spine; possibly resulting in a less exercise-related fracture.
Back bracing (core set, spinal orthoses) may be considered in the acute treatment phase after spinal fracture to help immobilize the spine, reducing pressure on fractured vertebrae and improving spinal alignment to allow for healing and to reduce pain. Bracing is the best considered as short-term management in particular circumstances; strong back muscles are the best long term brace.
Surgical Treatment
The aim of surgical treatment is decompression of the spinal cord canal and stabilization of the disrupted spinal column. The basic surgical procedures are done in management of the thoracolumbar spine. Much like any surgery, a spine surgery too comes with a fewpotential complications.
- Fusion: to join two separate bones into one to provide stability.
- Bone graft: bone harvested from one’s self (autograft) or another (allograft) for the purpose of fusing or repairing a defect.
- Kyphoplasty: the goal of kyphoplasty to stop pain caused by a spinal fracture and to stabilize the bone or restore the vertebral body height. It is a minimally invasive procedure.
- Vertebroplasty: a minimally invasive procedure used to treat vertebral compression fractures by injecting bone cement into the vertebral body.
- Spinal compression fracture (VCF): a break in the vertebral body of the spine is causing it to collapse and produce a wedge-shaped deformity.