SPINAL FRACTURES

The human spine is composed of 33 vertebrae, with 26 of them situated in the cervical, thoracic, and lumbar regions. These vertebrae are separated by flexible intervertebral discs and interconnected by intricate ligaments, facilitating mobility. The primary function of the spine is to maintain the body's upright posture and enable movement in various directions. Each vertebral bone contains rings that collectively form a canal through which the spinal cord traverses. This spinal cord is comprised of nerves that serve as conduits for communication between the brain and the rest of the body.

When a bone is subjected to excessive stress beyond its tolerance, a fracture may occur. The majority of spinal fractures (70%) typically manifest in the thoracic and lumbar vertebrae.

WHAT ARE THE CAUSES OF SPINE FRACTURES?

The primary etiologies of spinal fractures encompass trauma and osteoporosis. Spinal fractures predominantly afflict the younger demographic as a consequence of vehicular accidents, falls, and other traumatic incidents. Conversely, in the elderly population, such fractures are commonly precipitated by factors that compromise bone integrity, notably osteoporosis.

The occurrence of an osteoporotic vertebral fracture within an aging spine manifests in the development of a kyphotic deformity. This alteration exacerbates spinal misalignment, disrupting the harmonious distribution of load. The progression of spinal malalignment predisposes the individual to a series of subsequent fractures, initiating a cascade of fractures and heightening the risk of nonunion.

Additional culprits implicated in spinal fractures encompass primary bone neoplasms, multiple myeloma, metastatic tumors, and degenerative spinal pathologies.

WHAT ARE THE TYPES OF SPINAL FRACTURES?

Spinal injuries encompass a spectrum of severity, ranging from minor soft tissue trauma to spinal fractures and spinal cord injuries. Spinal fractures and dislocations have the potential to lead to spinal cord injury, resulting in paralysis.

Approximately 5-10% of fractures manifest in the cervical vertebrae, while around 70% occur in the dorsal and lumbar vertebrae, with the remaining percentage affecting the lower regions. The region most commonly affected is the junction of the dorsal and lumbar vertebrae, specifically the 12th dorsal and 1st lumbar vertebrae.

Spinal fractures can manifest in three primary ways.

Compression fractures: 

This is the most prevalent type of fracture, characterized by the collapse of only the anterior part of the vertebra. As a result of the fracture and subsequent collapse of the front wall of the vertebral body, the vertebra itself adopts a wedge-like shape. Given that the posterior wall of the spinal body remains intact, the spinal canal housing the spinal cord remains unaffected by the fracture. Compression fractures primarily arise from conditions such as osteoporosis and are more prevalent in elderly women.

Burst fractures: 

If the load on the spine is more severe, then the middle and back part of the vertebra may break and the broken pieces may be displaced towards the spinal canal and damage the spinal cord. Spinal cord injury and paralysis are common in burst fractures.

Fracture-Dislocations: 

These are the types that cause the most serious consequences, and include fractures in bones as well as dislocations and slips in joints and ligaments due to damage. The spinal cord and nerves are likely to be affected.

WHAT ARE THE SYMPTOMS OF SPINAL FRACTURES?

Spinal fractures can manifest through various symptoms that primarily involve discomfort in the neck, back, and lower back. These symptoms serve as crucial indicators of potential spinal issues and can vary in intensity depending on the severity of the fracture. For instance, mild fractures often present as persistent pain in the affected areas, making daily activities challenging and uncomfortable. On the other end of the spectrum, severe fractures that impact the spinal cord can result in more debilitating symptoms.

In cases where spinal cord impairment occurs, individuals may experience sensory deficits in their arms and legs, leading to numbness or weakness. Additionally, urinary incontinence can also be a notable symptom of severe spinal fractures, highlighting the profound impact such injuries can have on bodily functions. Without proper treatment and care, the consequences of untreated spinal fractures can be severe.

For instance, the development of spinal deformities like kyphosis, commonly referred to as a hunchback, can occur over time if the fracture is not addressed promptly. Furthermore, paralysis is another potential outcome of neglected spinal fractures, emphasizing the importance of early diagnosis and intervention. Therefore, recognizing the symptoms of spinal fractures and seeking medical attention promptly is crucial in preventing long-term complications and ensuring effective recovery.

DIAGNOSIS IN SPINE FRACTURES

From the moment a spinal injury is suspected, it is imperative to swiftly transport the patient to the nearest hospital in the appropriate manner. Failing to do so can significantly impact the outcome of the injury. Upon arrival at the emergency room, if there is a suspicion of injury, the initial examination that should be conducted is direct radiography (x-ray), which is often effective in determining the presence of an injury.

Computed Tomography provides a more detailed view of fractures compared to x-ray imaging, making it increasingly utilized in the assessment of trauma patients. This advanced imaging technique aids in evaluating the severity and specific type of fracture.

Magnetic Resonance Imaging (MRI) is the optimal method for evaluating the spinal cord and surrounding soft tissues. While not essential for every patient, it may be necessary to assess the extent of the fracture and soft tissue damage.

TREATMENT OF SPINE FRACTURES

The objective of the treatment is to alleviate the patient's pain, enhance their quality of life, and reinstate the mobility and stability of the spine. In cases where the nerves and spinal cord are impacted by the fracture, the goal is to alleviate the pressure on them and restore these structures to their normal functionality.

The majority of spinal fractures can be managed through non-invasive techniques. Tailored back braces are typically utilized based on the nature of the fracture. Surgical intervention should be contemplated for fractures that result in significant spinal deformity, when an impending collapse due to the existing fracture is anticipated, in instances of spinal cord impairment, in fractures deemed unstable, potentially leading to spinal cord paralysis, and in cases where union is not achieved within 3-6 months.

Custom-fit back brace treatment: 

It is particularly favored in patients with depression fractures and in individuals devoid of spinal cord injury or soft tissue damage. The objective is to facilitate the mending of the fracture through external fixation and to avert further collapse of the spine, thereby averting spinal cord compression and the emergence of kyphosis. The typical duration of treatment spans around 3 months.

There are three types of surgical treatment methods.

Vertebroplasty (Bone cement application), Kyphoplasty (Bone cement application with balloon): 

It is a minimally invasive therapeutic approach that is suitable for selected cases of depression fractures, osteoporosis or tumor-related fractures, as well as certain burst fractures. This procedure can be carried out under local anesthesia. The technique involves the insertion of large needles into the spine through small incisions on the skin, with the aim of realigning the fracture and reinforcing it by inserting a titanium cage and/or cement.

Fusion and stabilization: 

It involves realigning a fractured spine using metallic instruments and stabilizing it through bone fusion at the intervertebral joints. This surgical procedure can be carried out either from the anterior or posterior aspect of the spine, with the potential necessity of arthrodesis for bilateral bone fusion. Additionally, in cases of spinal cord injury, surgical intervention may entail the removal of bone fragments that are compressing the spinal cord. This method is the treatment of choice for burst fractures where the posterior ligament structures are compromised without associated neurological deficits, as well as for all other burst fractures or fractures and fracture-dislocations accompanied by neurological impairment.