Spine fracture

Any fracture that affects the spinal column or any of the bones within that area of the skeletal system is a spine fracture, also known as a vertebral fracture. Vehicle collisions and tough impacts from dives or falls from great heights are the most common spine fracture causes, which have the potential for catastrophic injury or death. Additional injuries also are common with this type of fracture because of the amount of force it takes to injure the spine. In the most severe cases, the fracture can affect the cervical vertebrae, in which case the neck breaks. There are seven cervical vertebrae in the neck, and if any one of them is broken, without intervention the neck may no longer be able to support the head and transport oxygen to the brain.

The most common types of spine fractures are compression fractures affecting the lower back (the lumbar spine), the mid-back (the thoracic) or the area where these two sections connect (the thoracolumbar junction). Men are about four times as likely as women are to fracture the lumbar or thoracic spine, and because of the effects of osteoporosis, all senior citizens are at a greater risk of fracturing the spine. 

There are many successful treatment options for most fractures affecting the spinal cord, and with ongoing maintenance, rehabilitation is possible. 

Anatomy of the spine

The spine, or vertebral column, consists of 33 vertebrae: 24 articulating vertebrae, capable of joint movement, and nine fused vertebrae that connect to the sacrum and coccyx (tailbone) at the lower back and pelvic region. The spine stretches from the neck to the tailbone. Discs separate each vertebra, allowing for a full range of motion and adjusting for the curvature of the spine in its natural posture. This part of the skeleton is extremely important, protecting the spinal canal and spinal cord, which receives messages from the brain.   

The vertebrae of the spine are grouped as follows:

  • 12 thoracic vertebrae (mid-back)
  • 7 cervical vertebrae (neck)
  • 5 lumbar vertebrae (lower back)
  • 5 vertebrae fused to the sacrum (part of the pelvic surface)
  • 4 vertebrae fused to the coccyx (tailbone)

Symptoms

There are many possible spine fracture symptoms, some of which are listed below. If you are experiencing any of these symptoms, it’s important to seek medical assistance right away to reduce the risk of additional fractures and other complications. Older women experiencing severe back pain, or anyone experiencing severe and sudden back pain, may be the victims of a spine fracture. Remember, not all spine fractures are caused by serious trauma. Also, not all fractures hurt immediately; some cause increased pain over time.

These are the most common spine fracture symptoms:

  • Sudden and severe back pain
  • Back pain that increases when walking or standing, and decreases when lying down
  • Difficulty twisting and bending
  • Reduced height
  • Spine is more curved than normal (or other spinal deformities)
  • Ongoing pain during everyday activities such as:
    • Bending to reach something on the floor
    • Lifting groceries, mattress corners or suitcases
    • Minor slips and missteps

The most serious type of spine fracture is one involving multiple breaks, which can dramatically alter the spinal column and damage internal organs. Again, not everyone will experience the same symptoms, so it’s important to seek immediate treatment from a medical expert. These are some of the common multiple spine fracture symptoms:

  • Loss in height caused by several vertebral collapses
  • Curved back (also known as kyphosis)
  • Stomach problems such as a bulging stomach and/or various digestive issues
  • Hip pain caused by the ribcage being closer to the hips
  • Difficulty breathing caused by severe vertebral compression

Causes

These are the most common spine fracture causes involving the lumbar and thoracic spine:

  • Accidents during high-impact sports
  • Conditions that result in frail bones, such as osteoporosis and tumors
  • Falls from great heights (such as diving into shallow water)
  • Vehicle crashes
  • Violent injuries (i.e. gunshot wounds and other traumas)

While spine fractures don’t always result from trauma, cervical fractures always require a great deal of force. Falls and vehicle collisions are the most common cervical spine fracture causes, as well as aggressive contact sports including football, hockey, soccer, rugby and wrestling. Some other sports such as diving, equestrianism, motor racing, mountain biking, power lifting, skiing, snowboarding and surfing also occasionally lead to a cervical fracture (broken neck).    

Types

There are many different types of spine fractures, but the most common are compression fractures of the mid or lower spine (i.e., the thoracic or lumbar spine). These may be categorized based on factors including the severity of the injury, the pattern of the fracture and whether the spinal cord was involved:  

  • Extension fractures – This type of fracture is typified by a pulling apart, or distraction, of the vertebrae. Head-on car collisions are a common cause, since the pelvis is kept in place by a seatbelt while the upper body is flung forward with great force. 
  • Flexion fractures – There are two types of flexion fractures that may occur in the spine, which often are caused by falls from great heights. If it is a compression fracture, the break will be stable, with the front vertebrae breaking and decreasing the height of the spine, as the back vertebrae are unaffected. If it is an axial burst fracture, both sides of the vertebrae are broken and reduced in height.
  • Rotation fractures – There are two types of rotation fractures: transverse process fractures, which are very rare and stem from extreme rotation or sideways bending, and fracture dislocations, which are more common and more unstable. The latter type of rotation fracture often involves displacement of vertebrae and damage to bones or soft tissue. 

The multidisciplinary team of spine and trauma experts at Northwell Health Orthopaedic Institute treats spine fractures as well as a broad range of conditions that affect the bones.

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