Spinal fractures
Vertebral Fractures - Definition
A spinal or vertebral fracture occurs when one or more of the bones of the spinal column breaks or cracks.
Your spine consists of many individual bones that are stacked up, one on top of the next, to form the spinal column. When one or more of these bones, called vertebrae, breaks or fractures, pieces of bone or bone fragments can pinch or compress the spinal cord or its nerves.
Reasons
Spinal or vertebral fractures can be caused by injuries or trauma, but they can also be due to conditions that weaken the bones of the spine.
Trauma
- Motor vehicle accidents: 45% of traumatic vertebral fractures are due to motor vehicle accidents
- Falls: Falls are responsible for 20% of traumatic vertebral fractures that occur
- Acts of violence: These account for 15% of traumatic vertebral fractures and include injuries such as gunshot wounds
- Sports-related injuries: Accidents related to sports are responsible for 15% of traumatic vertebral fractures
Traumatic events cause extreme movements of the body. This places a tremendous amount of pressure on the spine. When too much force is exerted on the spine, the vertebrae crack or break under the pressure. For instance, in the case of a diving accident, the neck is forced too far back, and the vertebral fracture under the extreme pressure.
Traumatic vertebral fractures occur most often in young people. 80% of people with traumatic vertebral fractures are between the ages of 18 and 25. They occur four times more often in men than in women.
When a condition like osteoporosis causes bones to weaken, your risk for vertebral fractures is increased. When bones are weak, sometimes even simple movements like coughing or sneezing can cause a vertebral fracture.
Conditions that Weaken Bones
- Osteoporosis
- Spinal tumors
- Bone cancer
Vertebral compression fractures (VCFs) are non-traumatic vertebral fractures. They are much more common in women, but also occur in older men. Vertebral fractures affect approximately one-quarter of all women past the age of menopause in the United States and it is estimated that over a third of all women over the age of 80 are affected.
Classification
Major and Minor Vertebral Fractures
One way vertebral fractures are sometimes classified is by whether they are major or minor:
- Minor: If a minor vertebral fracture has occurred, this means a part of the back portion (posterior) has broken. The posterior parts of the vertebra include the articular processes (also called the facet joints) and the spinous process. When the back portion of the vertebra breaks, it is not too serious because these parts are not as vital to the stability of the spine.
- Major: If a major vertebral fracture has occurred, this means part of the actual body of the vertebra has broken: the lamina or the pedicles. The vertebral body provides much support that is needed to keep the spine stable. These carry much of the weight of the body and help to evenly distribute the force of movement. If the lamina or pedicles are fractured, the vertebrae may be out of alignment. Major vertebral fractures are serious because they may lead to nerve damage and spinal instability.
Stable and Unstable Fractures
Another way to classify vertebral fractures is by whether they are stable or unstable:
- Stable: If a vertebral fracture is stable, it does not cause nerve (neurological) problems or spinal deformities. The spine is still capable of carrying and evenly distributing the weight of the body. There may be some impairment of course, but impairment is not severe.
- Unstable: If a vertebral fracture is unstable, the potential exists for it to progress and cause more damage. It is difficult for the spine to bear weight and distribute it evenly. These vertebral fractures may also cause deformities of the spine.
Specific Types of Fractures
In addition to a vertebral fracture being major or minor, stable or unstable, there are also various ways in which vertebrae can break. When a physician describes a vertebral fracture, he or she may use the following terms:
Compression Fracture
Compression fractures are common in people who have conditions such as osteoporosis or cancer that have weakened their bones. These conditions decrease the amount of pressure the bones are able to absorb. When force is applied to the weakened bone, it cannot absorb the stress, so it breaks or fractures.
One sub-type of compression fracture is a wedge fracture. In this type of break, one part of the vertebra, typically the front or anterior portion, collapses under stress and becomes shaped like a wedge.
Burst Fracture
When severe trauma such as a motor vehicle accident occurs, the vertebra can sometimes be crushed or broken in many places by extreme force. This is known as a burst fracture. When a vertebra is completely crushed, the bony pieces can displace and cause damage to the spinal cord. These fractures are more severe and dangerous than compression fractures.
Flexion-distraction Fractures
Extreme forward force can cause a flexion-distraction fracture of the spine. The spine is created with forwarding flexion, but if sudden and extreme movement forces it forward, the stress may cause one or more vertebrae to break. These fractures usually occur in the posterior and middle spinal column.
Fracture-dislocation
If a fracture causes significant movement of one or more vertebrae, dislocation occurs and the condition is called a fracture-dislocation. Generally, these fractures will involve the anterior, middle and posterior columns and cause a great deal of spinal instability.
Spinal Fracture Symptoms
Spinal fractures are not always painful, so even if you've been involved in something as traumatic as a car accident, you may not be aware that you have a vertebral fracture. It's important to always be examined by a physician following any traumatic accident and look out for spinal fracture symptoms.
The spinal fracture symptoms you have and how severe your symptoms are may vary, depending on the type of spinal fracture that occurred. Your spinal fracture symptoms may also depend on whether or not the fracture is disrupting nerve function.
Most of the time, spinal fractures cause severe and sudden pain and swelling at the site which is injured. If the fracture is compressing the spinal cord or a nerve, neurological spinal fracture symptoms may be present such as:
- Numbness or tingling in the legs or the arms
- Weakness in the legs or the arms
- Pain that radiates into the legs or the arms (radiculopathy)
- Problems moving or walking
- Problems with the bladder or bowels
- Inability to move (this is rare)
Spinal fractures accompanied by neurological complications are serious, so if any of the above spinal fracture symptoms are present, get medical attention right away, even if you don't have any pain.
Compression fractures are one type spinal fracture that is usually associated with conditions that cause bones to weaken, such as osteoporosis or cancer. These fractures can cause spinal fracture symptoms like an abnormal curve or hump in your back (kyphosis) or a loss of height.
Diagnostic Procedures
Most of the time following a traumatic accident, if a spinal fracture symptom is suspected you will be taken to an emergency department. You will probably be kept immobilized in a neck or back brace until the extent of your injuries can be determined. Doctors will assess your breathing and vital signs and examine your spine.
For individuals with spinal fracture symptoms, the break can even happen with a great degree of minor action, for example, wheezing, hacking, getting in or out of the bath, or just turning over in bed. The pain from an osteoporotic spinal fracture regularly keeps going around four to a month and a half as the bone recuperates, after which most patients report that the more extreme paint has died down and has transformed into to a greater degree an interminable, throbbing pain packed in the territory of the back where the crack happened.
This pain will normally improve following fourteen days, however, for a few people, it can proceed for a while. Moreover, a few patients encounter back agony long after the cracked bone has mended because of changed mechanics in the back and conceivably because of idleness.
Diagnostic imaging tests can help the doctors determine how your spine has been affected by your accident and the cause of your spinal fracture symptoms.
- X-rays: These are used to look at spinal vertebrae. Your doctor will be able to see if there are any fractures when he looks at x-rays of your spine. Special x-ray views such as extension and flexion x-rays may be completed to check for alignment of the vertebrae.
- Computed Tomography: A CT scan uses x-rays and a computer to produce cross-sectional images of your vertebral column. It is sometimes used with the injection of dye to make certain structures more visible. This helps the doctor further diagnose your condition.
- Magnetic Resonance Imaging: An MRI scan uses radio-frequency waves and powerful magnets to produce images of the non-boney portions of the spine. With this diagnostic test, the doctor can clearly see the nerves and spinal discs. This test is very useful in assessing injury to the spinal cord.
Spinal fractures may or may not be painful. If your vertebral fracture causes pain, your doctor may prescribe medications or have you try over-the-counter analgesics for spinal fracture treatment to help with pain control. These medications won't speed the healing process, but they can help you go about your activities of daily life more comfortably.
In most cases, it's best to start spinal fracture treatment with the lowest or weakest dose of medication that is still effective in managing your symptoms. Unless your pain is extremely severe, your physician will probably not prescribe a narcotic medication.
All medications, prescription drugs as well as herbal preparations and medications that are available over-the-counter, can cause side effects. Many spinal fracture treatment medications can interact with drugs you may be taking for another medical condition that is unrelated to your spinal fracture. For this reason, it's important to talk to your doctor before taking any medication, drug, or herb to help control your pain for the spinal fracture treatment.
Medications for spinal fracture treatment
- Acetaminophen: This medication is known by brand names such as Tylenol and it can be purchased over-the-counter. It is an effective analgesic (pain-relieving medication) but it does not have properties that enable it to decrease inflammation. This means if you have any swelling related to your fracture, acetaminophen will not be effective for reducing it. Acetaminophen is generally considered safe for most people because it doesn't have many side effects and is great for spinal fracture treatment.
- Non-steroidal anti-inflammatory drugs: These are sometimes called NSAIDs. Many of these types of medications are available over-the-counter and are known by brand names such as Motrin, Advil or Aleve. Motrin and Advil contain ibuprofen; Aleve contains naproxyn.Aspirin is also a NSAID. These spinal fracture treatment medications reduce inflammation in addition to relieving pain. Stronger NSAIDs like Celebrex, which is a COX-2 inhibitor, require a prescription from a physician. These medications have more side effects than acetaminophen, such as irritation of the lining of the gastrointestinal tract.
- Muscle Relaxants: These spinal fracture treatment medications are available only with a doctor's prescription. When the spine is compromised by a fracture, the muscles are often affected and painful muscle spasms sometimes result. Muscle relaxants help control pain by relaxing the muscles for spinal fracture treatment. Flexeril is an example of a muscle relaxant.
- Neuropathic Medications: Spinal fracture treatment medications that are used to specifically target nerve pain may be prescribed if your spinal fracture has disrupted nerve functioning. Cymbalta and Neurontin are examples of this type of medication.
- Opioids: Also known as narcotics, these are usually only used for very severe pain and only for limited periods of time for spinal fracture treatment. They require a physician's prescription. Opioids have the potential to cause severe side effects and they are also potentially addicting. Example of narcotics includes Fentanyl and Vicodin.
Wearing a brace
Your physician may recommend a brace be worn for spinal fracture treatment, depending on the type of fracture that has occurred. The purpose of a brace is to provide support for the spine as the fractured vertebrae heal. If the fracture is stable and there is little risk of damage to the nerves, the vertebrae can still to do their job of helping you move, but they are weakened by the fracture and need help to carry weight. A brace provides that help while the fracture heals. A brace also limits movement which helps with pain control as well as healing. Spinal fractures can be extremely painful and even slight movements can increase pain. A brace keeps movement to a minimum and gives the spine time to heal. Your physician will recommend what type of brace is best suited for the type of fracture you have suffered. In addition to custom-made braces, various types of braces used for spinal fracture treatment include:
- A cervical collar: A neck brace
- A thoracolumbar sacral orthosis: Also known as a TLSO, this is used for thoracolumbar fractures (fractures of the mid to lower back)
- A halo brace: This is used for fractures of the cervical (upper) spine and is a type of traction. It reduces pressure on the nerves or can help realign the vertebrae by gently pulling parts of the spine in different directions.
You will be instructed on how and when to wear your brace by your doctor or a nurse. Following these instructions is critical because the brace will enable your body to heal correctly. You will need to wear the brace exactly as instructed. If you're told to wear the brace constantly, that means you need to wear it 24 hours per day, even if it seems inconvenient.
Most times, a brace is not worn for very long because extended periods of bracing leads to weakened muscles. It's important for your muscles and bones to get used to bearing weight again as soon as possible. Physical therapy is almost always a part of a spinal fracture treatment. Therapy helps increase muscle strength following the removal of a brace. Your therapist can also teach you ways to keep your spine and back healthy.
Surgery
Whether or not a spinal fracture requires surgical intervention depends on the type of fracture that occurred, whether there is an injury to a nerve, and how unstable or misaligned the spine is. Since there are so many factors to consider, and since every patient is different with their own unique medical history and background, it is very difficult to predict exactly if, when or what type of surgery to expect for a traumatic fracture of the spine.
During spinal surgery, a surgeon may use an anterior approach (from the front) or a posterior approach (from the back) to access the spine. In extreme cases of deformity or spinal instability, an anterior-posterior approach may be necessary. Sometimes a procedure known as decompression is necessary. This operation is done to remove any parts of the spine that are compressing the spinal cord or its nerves and could cause neurological complications. Sometimes healthy parts of a vertebra need to be removed to create more space in the spinal canal.
Instrumentation Fusions are procedures that are used to treat unstable spinal fractures. In fusion, two adjoining vertebrae are connected with a bone graft between them. They are held in place with surgical hardware (instrumentation) such as rods, plates, cages or hooks and screws. In bone grafting, the goal is to join the two vertebrae into one piece of solid bone. The surgical hardware provides support for the vertebrae until the bones fully heal. Once the bones are fused together, in six to nine months, the instrumentation stays in place.
The bone graft for instrumentation and fusion is usually taken from a donor site in your own body or made from a biological material that will stimulate the growth of new bone. The new piece of solid bone provides long-term stability for the spine. Kyphoplasty and vertebroplasty are procedures that are often done to treat compression fractures.
Compression fractures are those that occur as a result of normal stress on bones that have been weakened by conditions like osteoporosis or cancer. Both of these procedures are minimally invasive and do not require extensive surgery. A needle is injected through the skin into the spine and through the needle, bone cement is used to fill or expand fractured or compressed vertebrae.
Physical therapy
Physical therapy is often part of the overall spinal fracture treatment plan to help you recover following a spinal fracture. Therapy will help you resume your activities of normal living. If a brace has been recommended by your physician, it will support your spine during the healing process but your muscles will need help to become stronger once the brace is removed.
A physical therapist will work with you to help you strengthen your muscles to support your spine so overall functioning can be restored. Your spine is aligned so the vertebrae evenly carry your weight and control movement. Spinal fractures can change the normal functioning of the spine. A fracture in one part of your back can affect the rest of your spine, adding stress to many different areas. The added stress can cause muscle strain and tension. The physical therapist can work with you to develop stretches and exercises that focus on relieving muscle stress and tension.
The therapist will make sure you do the exercises correctly and that they are effective. Make sure to follow your therapist's instructions because of this is an important part of your recovery. As your spinal fracture continues to heal, your therapist may add weight-bearing activities to your regimen. This generally includes activities like walking or weightlifting.
These activities help strengthen your bones. Good posture is especially important in the case of spinal fractures. If you round your back or hunch over, the pressure on your spine is increased and it is also more likely that the vertebrae will not heal in the correct alignment. Your physical therapist can teach you or help you re-learn posture techniques. A therapist can also help you learn safe and energy-saving ways to complete your tasks of daily life, such as how to load the dishwasher without straining your back, or the least painful way to get in and out of bed.
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Spine