Spinal Fracture

The most common symptom of any spinal fracture is pain, which typically gets worse with movement. For any fracture that causes spinal cord compression, spinal fracture symptoms can also include muscle spasms, numbness, weakness, tingling sensation, and paralysis.

Spinal fractures can be stable or unstable. Stable spinal fractures involve the front half of the spinal column, not involving the stabilizing facet joints. There is no neurological damage and the spine can still function and support body weight. An unstable fracture involves injuries to either or both the middle and posterior columns—including the back side of the bony vertebra and facet joints.

In the case of an unstable spinal fracture, there can be spinal deformity and signs of significant neurological damage—the person might also experience bladder or bowel incontinence or a loss of consciousness. A traumatic injury can cause other injuries that overwhelm the pain of the spinal fracture. These are called distracting injuries, and they may cause the person not to realize pain from a broken back. Always seek emergency care (call 911) for a suspected spinal fracture with or without nerve symptoms.

Osteoporosis or any other condition that weakens the bones is the most common cause of a compression fracture. These fractures are usually stable—when the front of a vertebra breaks but the back of the bone is intact. This is also called a wedge fracture because it looks like a wedge from the side view. Something as minor as bending over or twisting can cause a spinal compression fracture in a person with thinning bones.

Traumatic spinal fractures can occur after a significant force is directed on the spine, such as forceful twisting or direct impact. Causes include motor vehicle crashes, falls from a significant height, sports-related accidents, and acts of violence, such as a gunshot wound. These are often more serious breaks, such as dislocation of the backbone or crushing injuries to one or more vertebrae.

Osteoporosis is the main risk factor for compression fractures. Other conditions that can weaken bones and cause compression fractures include metastatic cancer that has spread to the spine and primary bone cancers.

Risk factors for burst, chance, and fracture-dislocation spinal fractures include:

• Being in a car or motor vehicle crash

• Participating in activities, sports and occupations with a risk of traumatic injury and/or falling from a height

• Male gender from 16 to 25 years old; this population is more likely to suffer a traumatic injury resulting in a spinal fracture

You may be able to lower your chance of getting a spinal fracture by:

• Getting regular physical exercise to strengthen your bones and back muscles, which provides more stability to your spine

• Getting enough calcium and vitamin D to prevent or slow osteoporosis development

• Using protective gear and correct technique during sporting activities

• Reducing your risk of falls, either by not engaging in the activity or by tethering yourself correctly

Spinal fracture treatment depends on the type and severity of the break as well as whether the spinal cord was damaged. Doctors also consider any other injuries that occur with the fractured vertebrae when determining the appropriate treatment.

Nonsurgical treatment is usually recommended for spinal compression fractures and stable burst fractures, which occur when both the front and back side of the vertebra breaks. A flexion/distraction fracture, also called a chance fracture, is a type of extension fracture in which a vertebra is pulled apart. These breaks are usually treated without surgery if the doctor can stabilize the spine with a brace or cast and if the posterior ligaments weren’t damaged.

Nonsurgical treatments include pain relievers and a brace, cast or collar to immobilize your spine and maintain proper alignment while the fracture heals. Spinal fracture recovery time is usually 6 to 12 weeks in a brace, depending on the severity of the break. Physical therapy for 1 to 2 months after the brace is removed will help you return to your normal activities.

More severe spinal fractures may require surgery to stabilize the spinal column and prevent permanent disability. Surgery is often needed to treat unstable burst fractures that result in several bone fragments or nerve damage from a pinched spinal cord. A flexion/distraction fracture with damaged posterior ligaments of the spine will often need surgery. Fracture-dislocation injuries almost always require surgery because they are usually very unstable breaks involving the spinal cord.  

The goal of surgical treatments is to stabilize the fracture and relieve any pressure on the spinal cord. A spine surgeon—either an orthopedic surgeon or neurosurgeon—will remove bones causing spinal cord compression. The surgeon may use a bone graft with metal hardware to fuse two (or more) vertebrae together and ensure the fracture is stable so it can heal properly.

Our spine is what allows us to move freely. A minor spinal fracture may not cause any long-term damage, but chronic pain and disability are possible. More significant fractures can lead to spinal deformity, chronic pain, and loss of mobility. Spinal nerve compression and spinal cord injury can introduce other complications like loss of sensation and paralysis.

Although the benefits of spinal fracture treatment usually far outweigh the risks, there are potential complications with spine surgery. Risks include bleeding, blood clots, infection and reaction to anesthesia. Other complications from spinal surgery include leaking of spinal fluid as well as nonunion, which is when that the fracture doesn’t heal properly even after the surgery.