Spinal Fracture - A Detailed Review

Introduction

Any trauma ranging from a simple accidental fall on the floor to a major road traffic accident can easily cause damage to the spine. Older adults lacking bone density also are prone to frequent spinal fractures. Certain fractures can be reduced with the help of rest and physical therapy, while others may require surgery. The outcome of the surgery can be noticed in a period ranging from one to three months. Further safety measures should be taken to prevent spinal fractures as well as the complications associated with them.

What Is a Spinal Fracture?

The spine (backbone) is made up of 33 bones called vertebrae. Any fracture or dislocation of vertebrae is called a spinal fracture. Spinal fractures may or may not be dangerous; however, the location and the extent of the injury determine the outcome. The cause of the fracture should be identified by following a proper treatment protocol.

What Are the Types of Spinal Fractures?

Spinal fractures are classified into various types based on the fracture's location, effect, and extent. Below is the list of spinal fractures:

• Compression Fracture - It is a type of fracture in which the anterior (front) portion of the vertebrae breaks and the posterior (back) portion of the bone remains intact. It does not change the position of the bones.

• Burst Fracture - It is a fracture in which both the anterior and posterior parts of the vertebrae are involved, showing a visible loss of height.

• Chance Fractures - It can be either a flexion or distraction type of fracture with a dislocation of the vertebrae.

• Stable - Compression fracture is stable because the bones remain in their original position.

• Unstable - Chance fractures are unstable fractures as they tend to change position.

• Major - It includes the fracture of the main part of the vertebrae, which halts significant functionality.

• Minor - It includes fracture of posterior segments of the vertebrae, which are called articular segments, and is not usually serious.

• Upper Spinal Fracture - Spinal fracture involving the occipital, atlas, and axis.

• Lower Spinal Fracture - Fractures involving the thoracic and lumbar spine portions.

Each fracture in a particular part can also be divided into Types I, II, and III based on the type of injury.

What Causes Spinal Fractures?

• Trauma - Trauma usually involves road traffic accidents, major blows to the back, sudden accidental falls, and so on.

• Metastatic Diseases - Spread of cancer cells from another part of the body to the spine.

• Osteoporosis - A condition in which there is a decrease in bone density which paves the way for fractures.

• Chemotherapy is a treatment for cancer patients that induces bone loss, making cancer patients prone to spinal fractures.

• Infections - Fractures as a result of the Infections.

• Hyperthyroidism - Hyperthyroidism can cause bone formation and resorption changes, reduced bone density, causing osteoporosis leading to bony fractures.

• Spinal Tumors - Spinal tumors damage the bone making it more susceptible to fractures.

Who Is at Risk for Spinal Fractures?

• Older adults.

• Female gender.

• People who have osteoporosis.

• Deficiency of vitamin D.

How Are Spinal Fractures Diagnosed?

• X-rays - It is an imaging technique in which the entire bony structure of the spine is visible, and it is easy to detect any changes in the normal spinal anatomy.

• Magnetic Resonance Imaging (MRI) - Produces three-dimensional images using magnets and computer technology.

• Axial CT or CAT scan - Computer-assisted tomography is a diagnostic technique including X-rays and computer technology to produce images.

• Myelogram of the Spine - It can be performed along with the CT scan where a dye is administered near the spinal cord that shows the narrowing of the associated structures along with outlines of bones.

• Dual-Energy X-Ray Absorptiometry (DEXA) - Also known as bone densitometry, is a process to check for decreased bone density. A scan of the entire body takes less than four minutes.

What Are the Indications of a Spinal Fracture?

Spinal fracture symptoms are dependent on the location and extent of the fracture.

• Pain in the back which becomes severe during movement.

• When the nerves are involved, there can be:

1. Tingling sensation.

2. Uncontrolled muscle spasm.

3. Numbness of the extremities.

4. Weakness in limbs.

What Are the Management Procedures for Spinal Fractures?

Spinal fractures can be treated depending on the type of fracture. Though there cannot be a guarantee of leading an everyday life soon after the surgery, one can lead an everyday life after proper rehabilitation.

• First, stabilize the patient using a cervical collar or any other materials.

• Relieve the pain using NSAIDs (non-steroidal anti-inflammatory drugs), thereby improving the functional status to some extent.

• Proper rest for a limited time can be used to treat minor fractures.

• For major spinal fractures, the surgical treatments carried out include

1. Vertebroplasty - It is a process in which a liquid cement is injected into the fractured vertebrae. It is a minimally invasive procedure that gets done in one hour. It shows a rapid reduction in pain.

2. Kyphoplasty - It is similar to vertebroplasty, except that it involves injecting a balloon to create a place for the treatment.

• Osteoporosis can be treated using proper medication, a healthy diet, and exercises to strengthen weak bones.

Physical and Rehabilitation Therapy - Strengthening, stretching, and stabilizing exercises are advised to maintain the outcome of the disease.

What Are the Complications Involved?

Damage to spinal nerves can cause an increase in blood pressure which can be life-threatening. Other complications include

• Pulmonary embolism - Blood clots in the lungs.

• Blood clots in the pelvis and legs.

• Pressure sores.

• Pneumonia - Infection of air sacs in the lungs.

Complications Associated With Surgery:

• Bleeding.

• Nonunion of the surgical area.

• Spinal fluid leak.

• Wound complications.

Measures to Prevent Complications:

1. Early treatment.

2. Medications.

3. Proper surgical technique.

4. Post-operative procedures, which include rehabilitation.

Conclusion

Spinal fractures, though common in most accidental falls, can also occur due to a deficiency of bone density, as seen in older adults. Spinal fractures treatment outcomes can be life-threatening when there is an injury to the nerves along with the spinal fracture. It is the cause, type, location, and extent of the fracture that determines the treatment protocol as well as the treatment outcome. Though some may face deficits in functionality, most people recover well over time.