Your spinal column, also known as the spine or backbone, includes more than two dozen bones called vertebrae.
The vertebrae play an important role in protecting your spinal cord, a crucial part of the central nervous system that helps control your body’s functions.
A traumatic force can cause one or more of your vertebrae to break, also known as a spinal fracture. Spinal fractures can range in severity, but the most severe can cause injury to the spinal cord.
Spinal Column Anatomy
Your vertebrae are grouped together into several different areas:
- 7 cervical (neck) bones.
- 12 thoracic (mid-back) bones.
- 5 lumbar (lower back) bones.
- 4 fused bones that form the sacrum.
- The tailbone, or coccyx.
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Types of Spinal Fractures
Fractures can occur at any part of the spine but are most common in the thoracic or lumbar vertebrae.
There are different types of spinal fractures:
- Compression fracture:
This happens when the front of the vertebra breaks and becomes compacted. While these fractures can be quite painful, compression fractures are usually stable, meaning the bones don’t move out of place. They are common in patients with
- Burst fracture: The vertebra loses height in both the front and back, so the spinal column itself loses height. Burst fractures are typically higher-energy injuries. They commonly happen in car accidents or falls from heights. This type of fracture can be stable or unstable, meaning bones could move out of place. Burst fractures also can cause nerve compression in your spinal cord.
- Chance fracture: This is a unique fracture pattern caused by a forward flexion and distraction of the spine. These injuries commonly occur at the thoracolumbar junction, which connects the lumbar and thoracic spine. The term chance fracture covers a variety of injuries. In severe cases, the vertebra or vertebrae can be completely pulled apart, resulting in an unstable fracture and possible neurologic injury. This can happen in a car accident where someone is wearing a lap belt without a shoulder restraint.
- Fracture-dislocation: This is a very severe injury that can involve multiple bones. A fracture-dislocation happens when a vertebra moves off an adjacent vertebra. These are highly unstable injuries and often cause spinal cord damage.
What Causes Spinal Fractures?
Compression spinal fractures occur often in older adults who have osteoporosis. A major trauma isn’t necessary to cause a spinal fracture in weakened bones. A fall from a standing height can cause a spinal fracture, as can daily activities like reaching, coughing or sneezing, or lifting a moderately heavy object.
Nearly 700,000 people experience vertebral compression fractures each year, according to the American Academy of Orthopaedic Surgeons. That’s nearly double the number of other fractures associated with osteoporosis, such as broken hips or wrists.
Tumors and other underlying health conditions also can weaken bones and lead to fractures.
In patients with healthier spines, fractures often occur after trauma. This includes:
- Motor vehicle accidents.
- Falls from significant heights.
- Sports injuries.
- Violence (i.e. gunshot wound).
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Symptoms of Spinal Fractures
The most common symptom of spinal fractures is neck or back pain that can get worse with movement. You may also experience swelling in the injured area.
If you have a spinal fracture resulting from osteoporosis, you may experience loss of motion and height, and eventual spinal disability or deformity.
If the fracture is affecting your spinal cord, other symptoms include:
- Weakness or numbness in your arms and/or legs.
- Pain radiating down your arms and/or legs.
- Difficulty moving or walking.
- Problems with bodily functions, such as bowel or bladder problems.
How Are Spinal Fractures Diagnosed?
Diagnosis of a spinal fracture often depends on how the injury occurs.
- If trauma isn’t involved, the diagnostic process usually begins with a physical examination by a doctor. The exam can help determine if pain is coming from your bones, muscles, or another source. Your doctor also may perform neurological tests to see if there are problems with your spinal cord. After that, imaging tests — such as x-rays, CT scans, and MRIs — can provide or confirm a diagnosis.
- In the case of trauma, emergency responders perform the first assessment of a patient and then transport them to a hospital. Emergency department doctors perform a more thorough physical examination. They also perform neurological tests to see whether the patient suffered any spinal cord or nerve injuries. That is followed by imaging tests like x-rays, CT scans, and MRIs to diagnose the fracture.
How Are Spinal Fractures Treated?
Depending on the severity of your injury, you may or may not need surgery to repair a spinal fracture and other damage.
Nonsurgical treatment for spinal fractures
For less severe spinal fractures, surgery may not be required.
Treatment may involve pain medicine, and doctors will recommend a decrease in physical activity to help your injury heal. You also may wear a brace to help the bones stay in place as they heal.
As you begin to heal, you may take part in rehabilitation, gradually increasing your physical activity.
Spinal fracture surgery
If you have an unstable spinal fracture, an injury that involves the spinal cord, or if nonsurgical treatment isn’t helping, surgery may be required. Depending on your injury, a minimally invasive procedure may be possible.
“We employ a variety of minimally invasive techniques to try and cause as little pain as possible while achieving maximal benefit,” says Jeremy Shaw, MD, director, Spine Education, UPMC.
The goals of surgery include stabilizing the fracture, returning vertebrae to the correct position, relieving pressure on the spinal cord and nerves, and allowing for early movement. Surgeons also may use metal rods and screws to stabilize your spine.
Common spinal fracture procedures include:
- Spinal fusion: This surgery joins two or more vertebrae together, using bone or metal rods and screws.
- Kyphoplasty: In this surgery for compression fractures, a surgeon puts a balloon device into a vertebra and inflates it. After deflating the balloon, the surgeon injects a cement-like substance into the space the balloon created. The procedure can stabilize the bone and relieve pain.
- Vertebroplasty: This minimally invasive procedure is similar to kyphoplasty, but without the balloon. Surgeons insert a needle through a small incision into the fractured area of your spine, then inject the cement-like substance.
If a spinal fracture results from trauma, other life-saving procedures may be needed before spinal surgery. If the injury involves the spinal cord as well, other procedures may be necessary. For example, a laminectomy relieves pressure on the spinal cord by removing all or part of the lamina, the thin part of the vertebrae.
Recovery from surgery depends on the extent of your injury and the procedure. For minor procedures, you may be able to resume normal activities within a day. For more severe fractures, you may need a lengthy hospital stay and rehabilitation.
For the most severe injuries, especially if the spinal cord is involved, you may not be able to regain full function.
Risks of spinal fracture surgery include blood clots, pulmonary embolisms, bleeding, infection, and nerve damage. But surgery also can help reduce pain and improve your ability to function.
“The ability to be pain-free when you walk or use your hands is pretty life-changing,” Dr. Shaw says. “That’s what we get to do, and we do it every day.”
Spinal Care at UPMC
From diagnosis to treatment, our multidisciplinary team of experts offers world-class support to each patient. Our surgeons have years of experience in treating the most challenging cases. We also work closely with UPMC Rehabilitation Services, providing patient referrals when therapy is needed.
For more information or to schedule an appointment, call 1-866-987-6784 (ORTHO) or visit us online.
American Academy of Orthopaedic Surgeons, Fractures of the Thoracic and Lumbar Spine. Link
American Academy of Orthopaedic Surgeons, Osteoporosis and Spinal Fractures. Link
American Association of Neurological Surgeons, Vertebral Compression Fractures. Link
Spine Health, When Back Pain is a Spine Compression Fracture. Link
About UPMC Orthopaedic Care
As a national leader in advanced orthopaedic care, UPMC treats a full range of musculoskeletal disorders, from the acute and chronic to the common and complex. Whether you have bone, muscle, or joint pain, we provide access to UPMC’s vast network of support services for both surgical and nonsurgical treatments and a full continuum of care. As leaders in research and clinical trials with cutting-edge tools and techniques, UPMC Presbyterian Shadyside appears on U.S. News & World Report’s rankings of the top hospitals in the country for orthopaedics.