Spinal Cord Injuries

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.

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.

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).

The treatment plan for a fracture of the thoracic or lumbar spine will depend on:

• Other injuries and their treatment
• The particular fracture pattern
• Once the trauma team has stabilized all other life-threatening injuries, the doctor will evaluate the spinal fracture pattern and decide whether spine surgery is needed.

Flexion Fracture Pattern

Nonsurgical treatment

Most flexion injuries (compression fractures, burst fractures) can be treated in a brace for 6 to 12 weeks. By gradually increasing physical activity and doing rehabilitation exercises, most patients avoid post injury problems.

Surgical treatment

Surgery is typically required for unstable burst fractures that have:

• Significant comminution (fracture fragments)
• Severe loss of vertebral body height
• Excessive forward bending or angulation at the injury site
• Significant nerve injury due to parts of the vertebral body or disk pinching the spinal cord
• These fractures should be treated surgically with decompression of the spinal canal and stabilization of the fracture.

Decompression involves removing the bone or other structures that are pressing on the spinal cord. This procedure is also called a laminectomy.

To perform the decompression, your surgeon may decide to access your spine with an incision either on your side or on your back.

Each approach allows for safe removal of the structures compressing the spinal cord, while preventing further injury.

Extension Fracture Pattern

The treatment plan for extension injuries will depend on:

• Where the spine fails
• Whether the bones can be fit together again (reduction) using a brace or cast

Nonsurgical treatment

Extension fractures that occur only through the vertebral body can typically be treated nonsurgically. These should be observed closely in a brace or cast for 12 weeks.

Surgical treatment

Surgery is usually necessary if there is an injury to the posterior (back) ligaments of the spine. In addition, if the fracture falls through the disks of the spine, surgery should be performed to stabilize the fracture.

Rotation Fracture Pattern

Nonsurgical treatment

Transverse process fractures are predominantly treated with gradual increase in motion, with or without bracing, based on comfort level.

Surgical treatment

Fracture-dislocations of the thoracic and lumbar spine are caused by very high-energy trauma. They can be extremely unstable injuries that often result in serious spinal cord or nerve damage. These injuries require stabilization through surgery. The ideal timing of these surgeries can often be complicated. Surgery is sometimes delayed because of other serious, life-threatening injuries.

Surgical Procedure

The ultimate goal for surgery is to achieve adequate reduction (fitting the bones together), relieve pressure on the spinal cord and nerves, and allow for early movement.

Depending on the fracture pattern, your surgeon may decide to do the procedure through an anterior (front), lateral (side), or posterior (back) approach, or a combination of all three.

Many types of instruments are used in surgery, including metal screws, rods, and cages to stabilize the spine.