(Article courtesy of the American Academy of Orthopaedic Surgeons)
Spinal fractures can vary widely in severity. While some fractures are very serious injuries that require emergency treatment, other fractures can be the result of bones weakened by osteoporosis.
Most spinal fractures occur in the thoracic (midback) and lumbar spine (lower back) or at the connection of the two (thoracolumbar junction). Treatment depends on the severity of the fracture and whether the patient has other associated injuries.
Fractures of the thoracic and lumbar spine may result from high-energy trauma, such as a:
- Car or motorcycle crash
- Fall from height
- Sports accident
- Violent act, such as a gunshot wound
Many times, these patients have additional serious injuries that require rapid treatment. The spinal cord may also be injured, depending on the severity of the fracture.
Spinal fractures may also be caused by bone insufficiency. For example, people with osteoporosis, tumors, or other underlying conditions that weaken the bone can fracture a vertebra even during low-impact activities–such as reaching or twisting. These fractures may develop unnoticed over a period of time, with no symptoms or discomfort until a bone breaks.
Treatment for a fracture of the thoracic or lumbar spine will depend on:
- Other injuries and their treatment
- The particular fracture pattern
Once the trauma team has stabilized all other life-threatening injuries, the doctor will evaluate the spinal fracture pattern and decide whether spine surgery is needed.
Flexion Fracture Pattern
Nonsurgical treatment. Most flexion injuries–including stable burst fractures and osteoporotic compression fractures—can be treated with bracing for 6 to 12 weeks. By gradually increasing physical activity and doing rehabilitation exercises, most patients avoid post-injury problems.
Surgical treatment. Surgery is typically required for unstable burst fractures that have:
- Significant comminution (multiple bone fragments)
- Severe loss of vertebral body height
- Excessive forward bending or angulation at the injury site
- Significant nerve injury due to parts of the vertebral body or disk pinching the spinal cord
These fractures should be treated surgically with decompression of the spinal canal and stabilization of the fracture. The procedure to decompress the spine is called a laminectomy.