LUMBAR BURST FRACTURE

Lumber Burst Fracture

Definition of a Burst Fracture

• Lumber Burst Fractures describe a type of high-energy traumatic vertebral fracture induced by flexion of the spine, which causes a compression force across the anterior and middle column of the vertebrae, causing the bone to enter into the spinal canal and crush the nerve components.
• A CT scan of the spine will confirm a fracture and provide information to repair the fracture by surgery.
• Depending on whether the patient has nerve damage and the stability of the fracture, the doctors will consider bracing or surgical decompression and stabilization.

A Lumbar burst fracture describes a spinal injury in which the vertebral body becomes compressed. These injuries usually occur because of significant trauma, such as a car accident or a fall from a height. A vertebra can become crushed if a lot of force gets applied vertically to the spine. When only the front section of the spine gets crushed, a wedge-shaped compression fracture results. A Lumbar Burst Fracture, on the other hand, occurs when the vertebral body gets compressed in all directions. The word “burst” refers to the vertebral body’s edges spreading out in all directions.

For two reasons, doctors consider a burst fracture far more serious than a compression fracture. The spinal cord can get injured because the bony edges stretch out in all directions. A bone fragment that pushes out and bruises the spinal cord might cause paralysis or partial nerve damage. The spine also becomes less stable than a compression fracture because the whole border of the vertebral body gets crushed.

Nerve Injury

A Lumbar Burst Fracture can cause nerve damage ranging from no harm to total paralysis. The amount of force present at the moment of the injury and the level of spinal canal damage determines the severity of nerve damage. When more bone fragments penetrate the spinal canal, more spinal cord function occurs. Below the level of the damage, this might result in a loss of strength, feeling, or reflexes. Paralysis of the legs and loss of bowel and bladder control occurs as a result of a burst fracture at the intersection of the thoracic and lumbar spines. Only partial paralysis or reflex loss occurs with a minor spinal cord injury. And transitory symptoms or partial nerve damage occur with moderate burst fractures.

Severe Pain From a Lumbar Burst Fracture

Burst fractures produce a lot of pain. The pain usually comes from the area where the fracture occurs in a person’s back. However, pain in the legs may occur as a result of the damaged nerve network. When the spinal cord becomes compressed, many patients experience an electric shock-like sensation in their legs. The majority of individuals with a  fracture can not walk right away due to the horrible pain.

Symptoms of a Lumbar Burst Fracture

Symptoms of a Lumbar Burst Fracture include the following:

• Back pain that appears moderate to severe and becomes worse with movement
• Fatigue, numbness, and tingling
• Change in bowel control loss

Diagnosis

Doctors find burst fractures during a patient’s exam in the emergency room at a hospital or medical institution after serious trauma. Doctors will need to know how the injury happened and will also look for any hidden injuries. To confirm a diagnosis, the doctor may conduct the tests listed below:

• X-ray (also known as plain films): An X-ray test produces pictures of bones using X-rays. The spinal cord, spinal nerves, discs, and ligaments, as well as most cancers, vascular problems, and cysts are normally not visible on X-rays. X-rays analyze bone anatomy, as well as the curvature and alignment of the vertebral column. X-rays can check for spinal dislocation or slippage (also known as spondylolisthesis), kyphosis, scoliosis, and local and general spine balance.  Also, X-rays can also detect specific skeletal anomalies including bone spurs, disc space constriction, vertebral body fracture, collapse, or erosion. Dynamic, or flexion/extension X-rays (X-rays that show the spine moving) evaluate whether any abnormal or excessive movement or instability exists.
• CT scan: a diagnostic imaging method that employs X-rays and computer technology to create pictures of any region of the body, including the bones, muscles, fat, and organs. General X-rays appear less detailed than CT scans.
• Magnetic resonance imaging (MRI) generates pictures of organs and structures within the body using a combination of powerful magnets, radiofrequency, and a computer. MRIs accurately view the spinal cord.

Risk Factors

Major trauma, such as a car accident or a hard fall, can produce a Lumbar burst fracture in a healthy spine. Burst fractures occur after a traumatic incident to the spine and often when the spine previously underwent a disease.

Treatments for a Lumbar Burst Fracture

Doctors see a Lumbar burst fracture as an injury that usually needs quick medical attention. If the burst fracture isn’t serious, meaning it hasn’t caused nerve or structural damage, the doctor may choose a nonsurgical treatment. If the burst fracture weakens the spine or caused compression of the spinal cord or nerves — leading to nerve damage — the doctor may suggest surgery. The treatment must always prioritize the patient’s needs based on the following choices.

• Decompression surgery involves the physician removing a bone compressing against the spinal cord or adjacent nerve roots.
• By removing the lamina (a technique known as a laminectomy) or the vertebral body (a procedure known as a corpectomy), the doctor will reduce pressure on the spinal cord and nerves.
• A spinal fixation and fusion provide the tools for a surgeon to restore the spine’s strength. The surgeon applies grafting material to allow bones to fuse together in these procedures. Doctors use Implants, such as screws and rods, to keep the spine in place while the bones fuse.

Conclusion

Lumbar burst fractures occur frequently. So, a thorough physical exam along with imaging tests should provide the doctor with enough information to correctly diagnose a lumbar burst fracture. In terms of a healthy spine and its nerves, lesions, and potential for kyphosis, doctors will classify the lumbar spine as stable or unstable. Each patient gets treated based on the severity of the lesions. Patients with stable fractures, no nerve damage, and kyphosis of fewer than 35 degrees should get non-surgical treatment. If a ligament appears as a problem, patients should undergo an MRI scan. Surgical treatment for unstable fractures should be standard. However, several surgeons lately proposed using instrumentation without fusion.  This treatment and its outcomes have yet to be analyzed using a large population. Finally, regardless of treatment, the doctor’s goals are all the same — stabilizing the spine, preserving function, and restoring balance.