Traumatic spine fractures and spinal cord injuries care

If you fracture one or more bones of the spinal column of the middle (thoracic) or lower (lumbar) back, it's a serious injury, usually caused by high-energy trauma such as a car crash, fall, sports accident or violent act.

Those with osteoporosis, tumors or other underlying conditions that weaken bone can get a spinal fracture with minimal trauma or normal activities of daily living. Men experience fractures of the thoracic or lumbar spine four times as often as women.

HonorHealth's doctors will classify fractures of the thoracic and lumbar spine based on the pattern of your injury.

• Compression fracture: While the front of the vertebra breaks and loses height, the back part of it does not. This type of fracture is usually stable and is rarely associated with neurological problems.
• Axial burst fracture: The vertebra loses height on both the front and back sides. It is often caused by a fall from a height when you land on your feet.
• Flexion/distraction fracture: The vertebra is literally pulled apart. This can happen in accidents such as a head-on car crash, in which the upper body is thrown forward while the pelvis is stabilized by a lap seat belt.
• Transverse process fracture: This fracture results from rotation or extreme sideways bending and usually does not affect stability.
• Fracture-dislocation: This is an unstable injury involving bone and/or soft tissue, in which one vertebra might move off the adjacent one.

Symptoms

The primary symptom of spinal fracture or spinal cord injury is moderate to severe back pain made worse by movement. When the spinal cord is also involved, numbness, tingling, weakness, or bowel/bladder dysfunction may occur.

Diagnosis

Your doctor will locate the fractured part or parts of your spine and determine the extent of the damage. The doctor will determine exactly how the vertebra broke, and whether there is nerve injury and/or spinal instability.

A neurological exam might also be needed. This may include tests of sensory (temperature, pain, and pressure sensitivity), motor (muscle strength) and reflex functions of your nervous system. If there is neurological damage, certain tests can show whether you might recover some function.

X-rays of the entire spine from multiple angles may be necessary to see bone alignment and check for damage to soft tissue. Sometimes, computed tomography (CT) or magnetic resonance imaging (MRI) scans are required to help the doctor better visualize your injury.

Treatment

Treatment goals include protecting nerve function and restoring alignment and stability of your spine. Your options will depend on the type of fracture and other factors.

Compression fractures and some burst fractures are usually treated without surgery. With a simple compression fracture, you might have to wear a hyper-extension brace for sitting and standing activities for six to 12 weeks.

With a transverse process fracture, you might need to wear a thoracolumbar corset and participate in an aerobic walking program.

Some spinal fractures require surgical treatment. Steroids may be prescribed if your spinal cord is also injured. Surgery may be necessary for unstable burst fractures, flexion-distraction injuries, or fracture-dislocation injuries. Surgery realigns the spinal column and holds it together using metal plates and screws and/or spinal fusion.