Acıbadem Comprehensive Spine Center
SPINAL DISORDERS SPINE FRACTURE

Spinal Fractures

Spine Fracture

Anatomy of the spine and the spinal cord

A biref overview of spinal anatomy will help to better understand the topic of spine fracture. The spine consists of 33 bones named vertebra and connected to each other with soft tissues, joints, and cushions between the vertebrae (disc). These vertebrae constitute a supportive structure which keeps the torso erect, and also provides movements in all directions (bending to the front and back, turning to the sides). Also, each vertebra has a ring shaped cavity at the back through which the spinal cord passes. Altogether these structures protect the spinal cord.

The spinal cord consists of a nerve tissue that provides connection and carries orders back and forth between the brain and the arms, torso, and legs. It works just as an electrical cable; it enables our hands and arms, feet and legs, and sensory function to work.

It also helps us to breathe, and controls our bladder and bowel functions.

What are spine injuries?

Spine injuries have a spectrum of severity ranging from a minor soft tissue injury to spine fracture and spinal cord injury. Fractures and dislocations of the spine may result in spinal cord injury, and therefore paralysis. The treatment options in spine injuries also change according to the severity of the case.

Which parts of the spine are fractured?

Five to ten percent of fractures are seen the neck vertebrae, 70% in the back and lower back vertebrae, and the rest in the lower parts. The most frequently injured part is the junction of the back (dorsal) and lumbar vertebra (12th dorsal vertebra and 1st lumbar vertebra), which is also the most mobile part of the spine.

How does a spinal cord injury occur?

Spinal cord injuries often result after spine fractures when the fractured bone narrows the canal through which the spinal cord passes. On the other hand, spinal cord injuries can rarely occur in the absence of any bone fractures, especially in children. Spine fractures and injuries can happen anywhere along the spine, beginning from the neck to the coccyx.

How many types of spine fractures are there?

Fractures:

When a load is exerted onto a bone greater than it can withstand, the bone fractues. The most frequent type of fractures are “compression fractures” where the front part of the vertebra collapses. If the load exerted on the spine is greater, then the middle and back parts of the vertebra may also fracture, and bone pieces may dislodge into the spinal cord canal, injuring the spinal cord. These types of fractures are called burst fractures. Although spinal cord injury and paralysis are frequent in burst fractures, not all burst fractures result in paralysis or spinal cord injuries. Fractures often involve a single vertebra, however in 20% to 30% of the cases another adjacent or nonadjacent vertebra can also be fractured.

Fractures and fracture-dislocations:

When loads exerted on the spine increase even further, in addition to bone fractures there may be injuries in the soft tissues that connect and hold the vertebrae together, discs, ligaments, and joints. In that case, the connection between the two vertebrae is torn and spinal dislocation may occur. Spinal dislocation is rarely observed a pure dislocation associated with soft tissue injuries, and more commonly it is seen as a fracture dislocation along with vertebral fracture. Spinal cord injury is often present in these two types of injuries, and they are among the most dangerous types of injuries. At the same time, the healing of dislocations or fracture dislocation is much more difficult compared to isolated fractures. Due to these reasons, dislocations or fracture-dislocations frequently require surgical treatment.

What are the symptoms of spine fractures?

The early phase symptoms of spine fracture vary according to the severity and location of the injury. Neck, back, and lower back pain with muscle spasm are the chief findings. When a spinal cord injury is also present, there may be various complaints such as numbness, lack of sensation in the arms and/or legs, loss of strength, urinary or fecal continence or conversely failure to pass out urine or stool.

In the long term, when patients without spinal injuries are inadequately treated spinal gibbosity (kyphosis) and the pain that it may create are the most common complaints. Patients with spinal cord injuries suffer from paralysis and its consequent problems.

What are the causes of spine fractures?

Spine fractures often develop due to high energy trauma. Traffic accidents are the most common causes. Others include falls from height, gunshot injuries, and sports injuries. In elderly patients with osteoporosis or in patients with spinal tumors the affected vertebral bones have weakened, and even low energy traumas may result in severe fractures.

Who are most commonly affected from spine fractures?

Eighty percent of patients with spinal fractures are in patients between ages 18-50. Men have four times greater risk of sustaining a spine fracture.

How is the diagnosis made in spine fractures?

In spinal injury cases transporting the patient to the nearest hospital and the way which this is performed is very important. Arrival of the ambulance and specialized paramedics should be waited for transport. Failure to transfer the patient in an appropriate position is one of the most important factors that determine the fate of injury. In the emergency room doctors perform the initial examination and treatment. The following studies may be requested for diagnosis.

Direct radiograph:

This is the first radiologic study that will be performed on patients with a suspicion of injury. In most cases it can effectively show whether there is an injury or not.

Computer tomography:

Shows the fractures better than direct radiographs. It is performed as a routine in some hospitals. In others, it may be performed to evaluate the severity and type of fractures already seen in direct radiographs.

Magnetic resonance imaging (MRI):

This is the best method in the evaluation of the spinal cord and soft tissues. It is not necessary in all patients; however it may be requested to assess the severity of the fracture and the condition of the soft tissues in patients diagnosed with fractures. This study may be also requested in spinal cord injuries with unexplained causes or when there is a discrepancy between the spinal cord injury and fracture levels.

What are the principles of management in spine fractures?

In patients without a spinal cord injury, the treatment aims to control the pain, achieve and restore the integrity of the spine. In an injured spine, the principal goals are to prevent the the progression of the destruction in time which may eventually result in a humpback, or to prevent the occurrence of a new injury absent in the beginning but later caused by the increasing humpback. In a patient who has spinal cord injury, efforts are made to correct conditions such as bone compression which causes the injury, or spinal cord compression. The application of this treatment during the early phase is important especially in patients with partial paralysis. This is because patients with partial paralysis have higher chances of healing. Patients with complete paralysis may have less chances of healing. However for early rehabilitation in these patients, the fractured spine needs to be rapidly reconstructed and its integrity should be restored.

Which treatments can be applied in spine fractures?

Brace or cast treatment:

K A stabilization is necessary for fracture healing. Brace or cast treatment is preferred especially in compression fractures without any spinal cord injuries or any soft tissue-connective tissue injuries. The aim is to achieve fracture union with external stabilization and to prevent further collapse of the spine, whose further collapse may cause compression of the spinal cord or lead to the development of gibbosity. Cast or brace treatment is generally continued for 3 months.

Instrumentation and fusion:

This is stabilization of the broken spine by metal devices with simultaneous fusion. This procedure can be performed either from the front and back, sometimes both sides need to be fused. Achieving fusion may take months. At the same time, in patients who have spinal cord injuries, bone pieces that compress the spinal cord may be removed during surgical intervention. In burst fractures without neurologic injury but with connective tissue injuries at the back, or in all other burst fractures with neurologic injuries, or in fractures and fracture dislocations, this is the preferred treatment method.

Vertebroplasty & kyphoplasty:

This is a minimally invasive treatment method that can be used in some selected compression fractures, in fractures caused by osteoporosis or tumor, and some burst fractures. It can be applied under local anesthesia. It is based on the concept that large caliber needles are inserted into the spine through small cuts on the skin, and titanium cage-cement is inserted for strenghtening.

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