treating Spine vertebrae fracture with surgical and non-surgical methods

Dr. Moradi, a neurologist

Spinal fractures are different than a broken arm or leg. A fracture or dislocation of a vertebra can cause bone fragments to pinch and damage the spinal nerves or spinal cord. Most spinal fractures occur from car accidents, falls, gunshot, or sports. Injuries can range from relatively mild ligament and muscle strains, to fractures and dislocations of the bony vertebrae, to debilitating spinal cord damage. Depending on how severe your injury is, you may experience pain, difficulty walking, or be unable to move your arms or legs. Many fractures heal with conservative treatment; however severe fractures may require surgery to realign the bones.

Types of Spinal Fractures

There are several types of spinal fractures based on pattern of injury and the extent of spinal cord injury. Below are the more common fractures.

  • Compression Fracture: This is often caused by osteoporosis or a tumor and rarely has spinal cord or nerve involvement. The front of the vertebra fractures and loses height however the back, posterior, part remains stable. It can be painful or asymptomatic and is usually a stable fracture.
  • Axial Burst Fraction: This is usually caused from a fall from a significant height, landing on the feet. The vertebra loses height on both the front and back side; depending on the stability of the fracture this may require surgery.
  • Chance Fracture: This fracture is known as a “seat-belt injury” and is caused by a violent forward flexed injury.  The vertebra is pulled apart, often from a car accident where the upper body is pulled forward while the pelvis is stabilized by a lap only seatbelt.

causes of spinal fracture 

Fractures of the thoracic and lumbar spine may result from high-energy trauma, such as a:

  • Car or motorcycle crash
  • Fall from height
  • Sports accident
  • Violent act, such as a gunshot wound

Many times, these patients have additional serious injuries that require rapid treatment. The spinal cord may also be injured, depending on the severity of the fracture.Spinal fractures may also be caused by bone insufficiency. For example, people with osteoporosis, tumors, or other underlying conditions that weaken the bone can fracture a vertebra even during low-impact activities--such as reaching or twisting. These fractures may develop unnoticed over a period of time, with no symptoms or discomfort until a bone breaks.

symptoms of spinal fracture

Symptoms of a spinal fracture vary depending on the severity and location of the injury. They include back or neck pain numbness, tingling, muscle spasm, weakness, bowel/bladder changes, and paralysis. Paralysis is a loss of movement in the arms or legs and may indicate a spinal cord injury. Not all fractures cause spinal cord injury and rarely is the spinal cord completely severed.

Diagnosis

The doctors will assess your breathing and perform a physical exam of the spine. The spine is kept in a neck or back brace until appropriate diagnostic tests are completed.

  • X-ray test uses x-rays to view the bony vertebrae in your spine and can tell your doctor if any of them show fractures. Special flexion and extension x-rays may be taken to detect any abnormal movement.
  • Computed Tomography (CT) scan is a safe, noninvasive test that uses an X-ray beam and a computer to make 2-dimensional images of your spine. It may or may not be performed with a dye (contrast agent) injected into your bloodstream. It is especially useful for viewing changes in bony structures.
  • Magnetic Resonance Imaging (MRI) scan is a noninvasive test that uses a magnetic field and radiofrequency waves to give a detailed view of the soft tissues of your spine. Unlike an X-ray, nerves and discs are clearly visible. It may or may not be performed with a dye (contrast agent) injected into your bloodstream. MRI is useful in evaluating soft tissue damage to the ligaments and discs, and assessing spinal cord injury.

 

Nonsurgical Treatment for Spinal Fractures

Pain from a spinal fracture allowed to heal naturally can last as long as three months. But the pain usually improves significantly in a matter of days or weeks.Pain management may include analgesic pain medicines, bed rest, back bracing, and physical activity.

Pain medications

pain medications can relieve bone-on-bone, muscle, and nerve pain. Over-the-counter pain medications are often sufficient in relieving pain. Two types of non-prescription medications -- acetaminophen and non-steroidal anti-inflammatory drugs (NSAIDs) -- are recommended. Narcotic pain medications and muscle relaxants are often prescribed for short periods of time, since there is risk of addiction. Antidepressants can also help relieve nerve-related pain.

Activity modification

Bed rest may help with acute pain, but it can also lead to further bone loss and worsening osteoporosis, which raises your risk for future compression fractures. Doctors may recommend a short period of bed rest for no more than a few days. However, prolonged inactivity should be avoided.

Back bracing

A back brace provides external support to limit the motion of fractured vertebrae -- much like applying a cast on a broken wrist. The rigid style of a back brace limits spine-related motion significantly, which may help reduce pain. Braces should be used cautiously and only under a doctor's supervision. Weakening and loss of muscle can occur with excessive use of braces for lumbar conditions.

Osteoporosis treatment

Bone-strengthening drugs such as bisphosphonates  help stabilize or restore bone loss. This is a critical part of treatment to help prevent further compression fractures.

Surgical Treatment for Spinal Fractures

When chronic pain from a spinal fracture persists despite rest, activity modification, back bracing, and pain medication, surgery is the next step. Surgical procedures used to treat spinal fractures are:

  • Vertebroplasty
  • Kyphoplasty
  • Spinal fusion surgery

Vertebroplasty and Kyphoplasty

These procedures for spinal fractures involve small, minimally invasive incisions, so they require very little healing time. They also use acrylic bone cement that hardens quickly, stabilizing the spinal bone fragments and therefore stabilizing the spine immediately. Most patients go home the same day or after one night's hospital stay.

Vertebroplasty

This procedure is effective for relieving pain from spinal compression fractures and helping to stabilize the fracture. During this procedure:

  • A needle is inserted into the damaged vertebrae.
  • X-rays help ensure that it's done with accuracy.
  • The doctor injects a bone cement mixture into the fractured vertebrae.
  • The cement mixture hardens in about 10 minutes.
  • The patient typically goes home the same day or after a one-night hospital stay.

Kyphoplasty

This procedure helps correct the bone deformity and relieves the pain associated with spinal compression fractures. During the procedure:

  • A tube is inserted through a half inch cut in the back into the damaged vertebrae. X-rays help ensure the accuracy of the procedure.
  • A thin catheter tube -- with a balloon at the tip -- is guided into the vertebra.
  • The balloon is inflated to create a cavity in which liquid bone cement is injected.
  • The balloon is then deflated and removed, and bone cement is injected into the cavity.
  • The cement mixture hardens in about 10 minutes.

Spinal Fusion Surgery

Spinal fusion surgery is sometimes used for spinal compression fractures to eliminate motion between two vertebrae and relieve pain. The procedure connects two or more vertebrae together, holds them in the correct position, and keeps them from moving until they have a chance to grow together, or fuse.Metal screws are placed through a small tube of bone and into the vertebrae. The screws are attached to metal plates or metal rods that are bolted together in the back of the spine. The hardware holds the vertebrae in place. This stops movement, allowing the vertebrae to fuse. Bone is grafted into the spaces between vertebrae.Patient's  bone or bone from a bone bank can be used to create a graft. The patient's own bone marrow or blood platelets -- or a bio-engineered molecule -- can be used to stimulate growth of bone for the procedure.Recovery from spinal fusion surgery takes longer than with other types of spinal surgery. Patients often have a three- or four-day hospital stay, with a possible stay on a rehabilitation unit. Patients typically wear a brace immediately after surgery. Rehabilitation is often necessary to rebuild strength and functioning. Activity level is gradually increased. Depending on the patient's age and health status, getting back to normal functioning can happen within two months or up to six months later.There are drawbacks to spinal fusion surgery. It eliminates the natural movement of the two vertebrae, which limits the person's movement. Also, it puts more stress on vertebrae next to the fusion - increasing the chance of fracture in those vertebrae. Even after healing is complete, patients may need to avoid certain lifting and twisting activities to prevent putting excess stress on the spine.

frequently asked questions

What are the risks of surgery? Is the surgery safe?

Risks of surgery include nerve injury, infection, bleeding, and stiffness.

how to prepare for spinal fracture surgery?

Quit smoking if you smoke, exercise on a regular basis to improve your recovery rate, stop taking any non-essential medications and any herbal remedies which may react with anesthetics or other medications and ask your surgeon all the questions you may have.

what is the recovery time after spinal fracture surgery?

Typically, braces are worn for six to 12 weeks after surgery in addition to three to six weeks of physical therapy.After kyphoplasty, patients are encouraged to resume normal activities as soon as possible, without any restrictions. Your doctor may recommend physical therapy and rehabilitation.