Spinal fracture

Medicine > Neurosciences

Definition and Epidemiology

• Spinal fractures refer to breaks or dislocations in the vertebrae, the bones that make up the spinal column.
• Can occur from trauma (e.g., car accidents, falls, sports injuries) or pathologically due to osteoporosis, tumors, or infection.
• Higher risk in individuals with osteoporosis, certain sports activities, and in those involved in high-impact trauma.

Types of Spinal Fractures

• Compression Fracture: Vertebrae collapse, common in osteoporosis.
• Burst Fracture: Vertebrae shattered, potentially sending bone fragments into the spinal canal.
• Flexion-Distraction (Chance) Fracture: Vertebrae pulled apart, often due to seatbelt injury in car accidents.
• Fracture-Dislocation: Bone fracture with dislocation, leading to instability of the spine.

Pathophysiology

• The mechanism of injury determines the type of fracture.
• High-energy trauma can cause more severe injuries, potentially affecting the spinal cord.
• Pathological fractures result from weakened bone structure due to underlying conditions.

Clinical Features

• Pain at the site of the fracture; can be severe.
• Neurological symptoms if the spinal cord or nerves are involved: numbness, weakness, paralysis.
• Limited mobility and deformity depending on the severity of the fracture.

Diagnosis

• Clinical assessment and detailed trauma history.
• Imaging: X-rays for initial assessment, CT for detailed evaluation, MRI if spinal cord injury is suspected.
• Neurological examination to assess for cord or nerve root injury.

Management

• Stabilization of the spine and patient is the first step.
• Pain management and immobilization.
• Surgical intervention may be necessary for unstable fractures, fractures with neurological involvement, or significant deformity.
• Conservative treatment (bracing, rest) for stable fractures without neurological involvement.
• Rehabilitation for recovery and prevention of complications.

Complications

• Spinal cord injury, leading to paralysis or sensory loss.
• Chronic pain.
• Post-traumatic deformity of the spine.
• Secondary complications due to immobility.

Prognosis

• Depends on the type of fracture, presence of spinal cord injury, and overall health of the patient.
• Stable fractures without neurological involvement generally have a good prognosis.
• Severe fractures with spinal cord involvement have a more guarded prognosis.

Prevention

• Preventing high-risk activities that lead to trauma.
• Management of osteoporosis and other conditions that weaken the bones.
• Use of protective gear in high-risk sports and activities.