Spine Surgery


A spinal fracture is a serious injury.

The most common fractures of the spine occur in the thoracic (midback) and lumbar spine (lower back) or at the connection of the two (thoracolumbar junction). These fractures are typically caused by high-velocity accidents, such as a car crash or fall from height.

Men experience fractures of the thoracic or lumbar spine four times more often than women. Seniors are also at risk for these fractures, due to weakened bone from osteoporosis.

Because of the energy required to cause these spinal fractures, patients often have additional injuries that require treatment. The spinal cord may be injured, depending on the severity of the spinal fracture.

Understanding how your spine works will help you to understand spinal fractures. Learn more about your spine: Spine BasicsSpine Basics (topic.cfm?topic=A00575)

Cause

Fractures of the thoracic and lumbar spine are usually caused by high-energy trauma, such as:

  • Car crash
  • Fall from height
  • Sports accident
  • Violent act, such as a gunshot wound

Spinal fractures are not always caused by trauma. For example, people with osteoporosis, tumors, or other underlying conditions that weaken bone can fracture a vertebra during normal, daily activities.

Types of Spinal Fractures

A compression fracture of the lumbar (lower) spine.
 

There are different types of spinal fractures. Doctors classify fractures of the thoracic and lumbar spine based upon pattern of injury and whether there is a spinal cord injury. Classifying the fracture patterns can help to determine the proper treatment. The three major types of spine fracture patterns are flexion, extension, and rotation.

Flexion Fracture Pattern

Compression fracture. While the front (anterior) of the vertebra breaks and loses height, the back (posterior) part of it does not. This type of fracture is usually stable and rarely associated with neurologic 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 and landing on the feet.

Extension Fracture Pattern

Flexion/distraction (Chance) fracture. The vertebra is literally pulled apart (distraction). 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.

Rotation Fracture Pattern

Transverse process fracture. This fracture is uncommon and results from rotation or extreme sideways (lateral) bending, and usually does not affect stability.

Fracture-dislocation. This is an unstable injury involving bone and/or soft tissue in which a vertebra may move off an adjacent vertebra (displaced). These injuries frequently cause serious spinal cord compression.


A side-view of a fracture-dislocation of a thoracic vertebra.
 

A magnetic resonance imaging (MRI) scan of a fracture-dislocation in the thoracic spine. Note the disruption of the spinal cord.
 
Symptoms

The primary symptom is moderate to severe back pain that is made worse by movement.

When the spinal cord is also involved, numbness, tingling, weakness, or bowel/bladder dysfunction may occur.

In the case of a high-energy trauma, the patient may have a brain injury and may have lost consciousness, or "blacked-out." There may also be other injuries — called distracting injuries — which cause pain that overwhelms the back pain. In these cases, it has to be assumed that the patient has a fracture of the spine, especially after a high-energy injury (motor vehicle crash).

Examination

Emergency Stabilization

At first evaluation, it may be difficult to assess the extent of injuries to patients with fractures of the thoracic and lumbar spine.

At the accident scene, EMS rescue workers will first check vital signs, including the patient's consciousness, ability to breathe, and heart rate. After these are stabilized, workers will assess obvious bleeding and limb-deforming injuries.

Before moving the patient, the EMS team must immobilize the patient in a cervical (neck) collar and backboard. The trauma team will perform a complete and thorough evaluation in the hospital emergency room.

Physical Examination


A CT scan taken from the side of a fracture-dislocation in the thoracic spine.
 

An emergency room physician will conduct a thorough evaluation, beginning with a head-to-toe examination of the patient. He or she will inspect the head, chest, abdomen, pelvis, limbs, and spine.

Investigation, Tests

Neurological tests. The doctor will also evaluate the patient's neurological status. This includes testin