Trauma | Spinal Fractures

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Spinal fractures that occur as a result of trauma are serious and potentially life-changing injuries that require urgent medical treatment. Sometimes such injuries, if they damage the spinal cord, can be fatal.

However, fractures of the spine can also develop without trauma. These types of fractures – called compression fractures – normally result in damage to the front of the vertebra while the back part remains stable preventing damage to the nerve or spinal cord. They may or may not be painful and are usually relatively stable.

Most spinal fractures occur in the middle of the back (thoracic) or lower back (lumbar), or where the two meet (thoracolumbar junction).

High impact trauma fractures are normally caused by road traffic accidents, sporting injuries or a fall from a height. The most obvious symptom of a trauma-related fracture is pain in the back, which can be severe and is worsened by movement. If the spinal cord is damaged, there may be bladder or bowel dysfunction or numbness/weakness in the limbs.

High impact trauma fractures may also result in brain injuries and, where there are other injuries (distracting injuries) the pain of these may overwhelm the back pain masking the spinal fracture initially.

Patients may also fracture the bones in their neck – the cervical vertebrae. This is a potentially serious or life-threatening injury as damage to the spinal cord, which runs through these vertebrae, can cause paralysis or even death.

If you have a trauma fracture, the clinical team will perform a range of tests to determine the type and extent of your injury. These include:

  • Neurological tests including how well you can move, feel and sense the position of your limbs. Your reflexes will be tested to determine if the spinal cord or nerves have been injured.
  • Imaging tests including X-rays, CT scans and MRI scans may be carried out to ascertain the extent of damage to bone and soft tissues.

The treatment you receive for trauma and spinal fracture will depend on where the fracture is, how severe it is and whether there are other associated injuries including neurological damage.

Initially, if you have a trauma fracture, an ambulance crew will check and stabilise your vital signs and deal with major blood loss. Before you are moved you will be immobilised using a neck collar and backboard.

Once the trauma team has stabilised any life-threatening injuries, doctors will assess the results of your diagnostic tests and decide if you need surgery.

All surgical procedures aim to return the bones to their proper position, relieve pressure on the spinal cord and nerves and allow for a gradual return to movement. Metal screws, rods and cages may be used to stabilise the spine.

Rehabilitation is an important part of recovery as it can help to relieve pain, restore mobility and regain as much movement as possible.

There are several ways to prevent serious injury to your spine due to trauma.

  • Always wear a seatbelt in a vehicle and use the correct protective equipment when you are playing sport or riding horses, bikes or motorbikes.
  • Avoid diving headfirst into shallow water.
  • If you have osteoporosis, your doctor will talk to you about avoiding compression fractures.
Spinal fractures

Spinal fractures that occur as a result of trauma are serious and potentially life-changing injuries that require urgent medical treatment. Sometimes such injuries, if they damage the spinal cord, can be fatal.

However, fractures of the spine can also develop without trauma. These types of fractures – called compression fractures – normally result in damage to the front of the vertebra while the back part remains stable preventing damage to the nerve or spinal cord. They may or may not be painful and are usually relatively stable.

Most spinal fractures occur in the middle of the back (thoracic) or lower back (lumbar), or where the two meet (thoracolumbar junction).

Causes

High impact trauma fractures are normally caused by road traffic accidents, sporting injuries or a fall from a height. The most obvious symptom of a trauma-related fracture is pain in the back, which can be severe and is worsened by movement. If the spinal cord is damaged, there may be bladder or bowel dysfunction or numbness/weakness in the limbs.

High impact trauma fractures may also result in brain injuries and, where there are other injuries (distracting injuries) the pain of these may overwhelm the back pain masking the spinal fracture initially.

Patients may also fracture the bones in their neck – the cervical vertebrae. This is a potentially serious or life-threatening injury as damage to the spinal cord, which runs through these vertebrae, can cause paralysis or even death.

Diagnosis

If you have a trauma fracture, the clinical team will perform a range of tests to determine the type and extent of your injury. These include:

  • Neurological tests including how well you can move, feel and sense the position of your limbs. Your reflexes will be tested to determine if the spinal cord or nerves have been injured.
  • Imaging tests including X-rays, CT scans and MRI scans may be carried out to ascertain the extent of damage to bone and soft tissues.
Treatment

The treatment you receive for trauma and spinal fracture will depend on where the fracture is, how severe it is and whether there are other associated injuries including neurological damage.

Initially, if you have a trauma fracture, an ambulance crew will check and stabilise your vital signs and deal with major blood loss. Before you are moved you will be immobilised using a neck collar and backboard.

Once the trauma team has stabilised any life-threatening injuries, doctors will assess the results of your diagnostic tests and decide if you need surgery.

All surgical procedures aim to return the bones to their proper position, relieve pressure on the spinal cord and nerves and allow for a gradual return to movement. Metal screws, rods and cages may be used to stabilise the spine.

Rehabilitation is an important part of recovery as it can help to relieve pain, restore mobility and regain as much movement as possible.

Prevention

There are several ways to prevent serious injury to your spine due to trauma.

  • Always wear a seatbelt in a vehicle and use the correct protective equipment when you are playing sport or riding horses, bikes or motorbikes.
  • Avoid diving headfirst into shallow water.
  • If you have osteoporosis, your doctor will talk to you about avoiding compression fractures.

There are three major types of spinal fracture – Compression, Flexion Distraction and Rotation – which have a range of different causes:

Compression (Flexion) Fractures

These include:

  • Axial burst fractures which often result from a fall where the person lands on their feet. There is damage to the front and back of the vertebra and it may require surgery.
  • Compression fractures which usually develop as a result of the bones becoming weakened due to osteoporosis, tumours or spinal infections. These fractures may develop unnoticed over a period of time and have no symptoms until the bone breaks. They are rarely associated with neurological problems.

Many can be treated with bracing for six to 12 weeks. Rehabilitation is important to avoid post-injury problems.

Unstable burst fractures may require surgery using indirect reduction with screws and rods.

Occasionally, this may be combined with a laminectomy, which involves removing the bony arch at the back of the spinal canal to relieve any pressure on the underlying neural structures.

Causes

These include:

  • Axial burst fractures which often result from a fall where the person lands on their feet. There is damage to the front and back of the vertebra and it may require surgery.
  • Compression fractures which usually develop as a result of the bones becoming weakened due to osteoporosis, tumours or spinal infections. These fractures may develop unnoticed over a period of time and have no symptoms until the bone breaks. They are rarely associated with neurological problems.
Treatment

Many can be treated with bracing for six to 12 weeks. Rehabilitation is important to avoid post-injury problems.

Unstable burst fractures may require surgery using indirect reduction with screws and rods.

Occasionally, this may be combined with a laminectomy, which involves removing the bony arch at the back of the spinal canal to relieve any pressure on the underlying neural structures.

Flexion Distraction Fractures

These include:

  • Chance fractures, which are caused by the vertebra being pulled apart (distraction), often as a result of a head-on car accident where the upper body is thrown forward while the pelvis remains held against the seat by a seatbelt.

Treatment will depend where the damage occurs and whether the bones can be fitted together using a brace or cast.

If the fracture is only in the vertebral body it can usually be treated by the patient wearing a brace for 12 weeks.

If there is injury to the back ligaments of the spine or if the fracture falls through the disks of the spine you may need surgery to stabilise the fracture.

Causes

These include:

  • Chance fractures, which are caused by the vertebra being pulled apart (distraction), often as a result of a head-on car accident where the upper body is thrown forward while the pelvis remains held against the seat by a seatbelt.
Treatment

Treatment will depend where the damage occurs and whether the bones can be fitted together using a brace or cast.

If the fracture is only in the vertebral body it can usually be treated by the patient wearing a brace for 12 weeks.

If there is injury to the back ligaments of the spine or if the fracture falls through the disks of the spine you may need surgery to stabilise the fracture.

Rotation Fractures

These include:

  • Transverse process fractures, which are relatively uncommon and are the result of rotation of extreme sideways bending.
  • Fracture-dislocation, which occurs when a vertebra moves off an adjacent vertebra. This causes serious spinal cord compression and is a very unstable injury.

Transverse process fractures are normally treated by gradually increasing the motion in the spine, without bracing.

Fracture-dislocation of the thoracic and lumbar spine is an unstable injury that can result in serious spinal cord or nerve damage.

It normally requires surgical stabilisation but surgery may have to be delayed if there are other life-threatening injuries.

Causes

These include:

  • Transverse process fractures, which are relatively uncommon and are the result of rotation of extreme sideways bending.
  • Fracture-dislocation, which occurs when a vertebra moves off an adjacent vertebra. This causes serious spinal cord compression and is a very unstable injury.
Treatment

Transverse process fractures are normally treated by gradually increasing the motion in the spine, without bracing.

Fracture-dislocation of the thoracic and lumbar spine is an unstable injury that can result in serious spinal cord or nerve damage.

It normally requires surgical stabilisation but surgery may have to be delayed if there are other life-threatening injuries.