LUMBAR BURST FRACTURE

Trauma to the Spine

In scenarios where the force is significant, bone fragments may intrude into the spinal canal, leading to varying degrees of spinal cord damage. This can range from minor loss of function to severe cases such as complete paralysis. The vertebral body, normally protecting the spinal cord, can fracture and disrupt this delicate balance. When these fractures occur, parts of the vertebral body might collapse and encroach upon the spinal canal’s space.

Impact on the Spinal Structure:

• The spinal canal, a rigid bony tube, cannot expand. Therefore, any intrusion by bone fragments or protruding vertebrae significantly reduces the available space for the spinal cord and nerves.

What is a Spinal Compression Fracture?

A spinal compression fracture happens when the vertebrae in the spine collapse under pressure. This type of fracture typically results from osteoporosis, trauma, or metastatic disease.

Key Points:

• Osteoporosis: Weakened bones due to decreased bone density are more prone to breaking.
• Trauma: Injuries from accidents or falls can compress the vertebrae.
• Metastatic Disease: Cancer spreading to the bones can cause them to become brittle and easily fractured.

Symptoms:

1. Sudden Back Pain: Often localized and severe.
2. Decreased Mobility: Difficulty moving or performing daily activities.
3. Loss of Height: Multiple fractures can lead to a noticeable reduction in height.

Proper treatment is crucial for managing pain and preventing further damage. Options often include physical therapy, medications, and in some cases, surgical interventions.

Understanding Spinal Compression Fractures

Spinal compression fractures occur when the bones in the spine (vertebrae) become compromised. These fractures generally come in three varieties, each with its own unique characteristics and implications for spinal health.

Wedge Fracture

Among the most common, wedge fractures typically affect the front portion of the vertebra. This type of fracture causes the front of the vertebra to collapse, while the back remains intact, resulting in a wedge-like shape. Despite being mechanically stable, wedge fractures can lead to spinal deformities such as a kyphotic or hunchback posture.

Crush Fracture

Crush fractures involve more comprehensive damage, affecting the entire vertebra rather than just a portion. In these cases, the bone compresses uniformly, potentially collapsing in on itself. Although these fractures are generally stable, the overall integrity of the vertebra is compromised.

Burst Fracture

Burst fractures are particularly severe and unstable. In this scenario, the vertebra shatters in multiple directions, often dispersing fragments into surrounding tissues or even the spinal cord. Due to their complexity and risk, burst fractures necessitate urgent medical intervention.

Key Characteristics of Spinal Compression Fractures

• Wedge Fracture: Collapse at the front of the vertebra; mechanically stable but may cause spinal deformity.
• Crush Fracture: Comprehensive collapse of the entire vertebra, generally stable but affects structural integrity.
• Burst Fracture: Multi-directional collapse with bone fragments, highly unstable and requiring immediate medical attention.

Understanding these different types of spinal compression fractures can help in recognizing the symptoms and seeking appropriate medical care swiftly.

How Does Pain Vary Among Patients with Spinal Compression Fractures?

The pain experienced by patients with spinal compression fractures can differ greatly. Some individuals may not feel any discomfort, allowing them to continue their daily activities without interruption. On the other hand, some suffer from intense, debilitating pain that severely impacts their quality of life and restricts their movement.

Several factors contribute to this variation in pain levels:

• Location of the Fracture: The specific area of the spine where the fracture occurs can influence the intensity of pain.
• Severity of the Fracture: Minor fractures may cause little to no pain, while severe breaks can lead to significant discomfort.
• Patient Health: Overall health and preexisting conditions, such as osteoporosis, can affect how pain is perceived and managed.
• Lifestyle and Activity Level: People who are more physically active might experience different pain levels compared to those with a sedentary lifestyle.

In summary, the range of pain associated with spinal compression fractures is broad, from non-existent to excruciating, influenced by multiple individual-specific factors.

Where in the Spine Do Compression Fractures Typically Occur?

Compression fractures most often happen in the thoracic region of the spine, which encompasses the T1 to T12 vertebrae. These fractures are particularly common in the lower part of this region but are less likely to occur above the T7 vertebra.

In addition to the thoracic spine, compression fractures can also occur in the lumbar spine, specifically between L1 and L5. This area supports much of the body’s weight, making it another common site for these types of fractures.

Consequences of Compression:

• This compression can increase the risk of irritation or serious injury to the spinal nerves. The extent of damage often depends on the degree of encroachment into the spinal canal and the specific area of the spine affected.

Understanding these mechanisms is crucial, as they explain how seemingly similar injuries can result in a wide spectrum of neurological symptoms, from mild discomfort to complete loss of motor function below the injury site.

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 occur 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. Transitory symptoms or partial nerve damage occur with moderate burst fractures.

A burst fracture is aptly named because, as the vertebra collapses, it breaks out in multiple directions, often sending pieces of shattered bone into the surrounding tissues of the spine or the spinal cord. This type of fracture is usually more serious than either a wedge or a crush fracture and is more likely to be unstable.

Moreover, the force and direction of the injury play crucial roles in determining the extent of complications. When bone fragments are displaced, they can impinge on the spinal cord, leading to varying degrees of neurological deficits. Immediate medical attention is often required to prevent further damage and stabilize the spine.

In summary, the potential complications of a lumbar burst fracture include:

• Varying degrees of nerve damage from no harm to total paralysis
• Loss of strength, feeling, or reflexes below the level of the injury
• Paralysis of the legs, and loss of bowel and bladder control
• Instability of the spine due to fractured vertebrae
• Immediate need for medical intervention to prevent further complications

Understanding these risks underscores the importance of timely and appropriate medical care.”

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. Furthermore, certain medicines like Corticosteroids can increase the risk of getting a burst fracture.

Prolonged Use of Corticosteroids Can Increase The Risk of Burst Fractures:

• Corticosteroids and Bone Health: Corticosteroids, often prescribed for inflammation and autoimmune diseases, can have negative side effects on bone health.
• Reduced Bone Density: Long-term use of corticosteroids can lead to a decrease in bone mineral density. This weakens bones and makes them more susceptible to fractures.
• Impaired Bone Formation: Corticosteroids can interfere with the body’s natural process of building new bone tissue.
• Increased Fracture Risk: As bone density weakens and bone formation slows, the risk of fractures, including burst fractures, increases, particularly in the spine.

Decreasing the risk of a Burst Fracture when on corticosteroids for a lengthy period

When individuals are prescribed corticosteroids, managing both pain and the increased risk of fractures that can come with prolonged usage is crucial. To address this, your healthcare provider may consider adjusting your medication regimen. Here are some potential actions doctors may take:

• Modify Dosage: The doctor might reduce the dose of corticosteroids to decrease potential side effects while still providing pain relief.
• Medication Review: Review all current medications to assess their cumulative impact on bone density and overall health.
• Alternative Therapies: Introducing or suggesting alternative therapies or medications that do not exacerbate fracture risk.
• Regular Monitoring: Implementing a schedule for regular check-ups to closely monitor the effects of the medication changes and ensure that both pain and bone health are managed effectively.

By taking these steps, doctors aim to strike a balance between effective pain management and minimizing the risk of fractures associated with long-term corticosteroid use.

What are the Common Causes of Spinal Compression Fractures?

Spinal compression fractures often result from conditions that weaken the vertebrae. The most prevalent cause is osteoporosis, a disease that reduces bone density and strength. When vertebrae are compromised by osteoporosis, even everyday activities and minimal stress can lead to fractures.

Another significant cause is cancer, particularly metastatic cancer that spreads to the bones. Tumors can erode bone structure, making the spine highly susceptible to fractures.

Key Causes:

• Osteoporosis: The leading culprit, is that diminished bone density makes vertebrae fragile.
• Cancer: Especially metastatic cancers that target bone tissues.
• Other Diseases: Conditions like osteomalacia or Paget’s disease also contribute to weakened bones.

Understanding these common causes can help in both preventing such fractures and seeking appropriate medical intervention.

Symptoms of a Lumbar Burst Fracture

Symptoms of a Lumbar Burst Fracture include the following:

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

What Should a Patient with Vertebral Fracture Symptoms Do for a Medical Evaluation?

If you’re experiencing symptoms such as severe back pain, unexpected height loss, or a hunched posture, it’s essential to seek medical attention. Here’s a step-by-step guide on what to do:

• Schedule a Visit to Your Primary Care Physician
  Your primary care doctor is your first point of contact. They can perform an initial assessment and provide a referral to a specialist if needed.
• Consult a Spine Specialist
  Depending on your symptoms, your doctor might refer you to an orthopedic surgeon or a neurologist who specializes in spinal conditions.
• Undergo Diagnostic Imaging
  Common procedures include X-rays, MRIs, or CT scans. These imaging techniques help in accurately diagnosing the fracture and assessing its severity.
• Discuss Your Symptoms Thoroughly
  During your consultation, be sure to describe all your symptoms in detail. This helps in forming a comprehensive treatment plan. Mention if the pain radiates to other areas, or if you experience numbness or weakness.
• Follow the Recommended Treatment Plan
  Treatment options can vary from physical therapy and medications to surgical interventions. Adhere to the plan given by your healthcare provider for optimal recovery.

By taking these steps, you ensure a proper medical evaluation and a targeted approach to managing your symptoms.

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. X-rays do not show spinal nerves, discs, and ligaments, as well as most cancers, vascular problems, and cysts. 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 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.

Nerve Injury from Lumbar Burst Fractures

Burst fractures are a serious type of injury to the spine that can vary widely in their effects on nerve injury and neurological functions, depending on several factors. The primary determinant is the severity of the fracture, which is influenced by the degree of force exerted during the injury. This force dictates how much the spinal canal, which houses the spinal cord, is compromised.

Key Impacts on Neurological Function:

• Minor to Severe Neurological Compromise: In scenarios where the force is significant, bone fragments may intrude into the spinal canal, leading to varying degrees of spinal cord damage. This can range from minor loss of function to severe cases such as complete paralysis.
• Location-Specific Consequences: The location of the burst fracture also plays a critical role in the outcome. For instance, fractures at the juncture of the thoracic and lumbar spine can lead to paralysis in the legs, as well as affect control over bowel and bladder functions.
• Residual Effects: In cases of less severe burst fractures, symptoms might be temporary, possibly involving only minor and transient neurological symptoms or no noticeable symptoms at all. However, even mild burst fractures can cause a degree of nerve impairment, which might include partial paralysis or a decrease in reflex actions.

This broad range of potential outcomes highlights the critical nature of burst fractures in terms of spinal health and nerve function, emphasizing the importance of immediate and effective medical intervention to mitigate long-term damage.

Understanding Clinical Trials and Their Role in Spinal Fracture Treatments

Clinical trials are essential research studies designed to evaluate new treatments, such as drugs, diagnostics, procedures, vaccines, and other therapies, on human participants. These trials help determine the safety and effectiveness of emerging medical interventions.

Why Are Clinical Trials Important for Spinal Fracture Treatments?

• Innovative Solutions: Clinical trials provide a pathway for discovering cutting-edge treatments that could offer better outcomes for spinal fracture patients.
• Safety and Efficacy: By rigorously testing new therapies, clinical trials ensure that only the safest and most efficacious treatments reach the market.
• Customized Care: Participation in clinical trials often means access to advanced care options that are not yet widely available.

How Do Clinical Trials Work?

• Eligibility: Each trial has specific criteria that participants must meet, such as age, type of spinal fracture, and overall health status.
• Protocol: The protocol outlines the treatment plan, including dosages, schedules, and procedures, that the trial will follow.
• Locations: Trials are conducted at various hospitals, clinics, and research centers. Information about participating locations is publicly accessible.

Finding Clinical Trials for Spinal Fracture Treatments

To explore ongoing clinical trials, start by visiting websites like:

• ClinicalTrials.gov: A comprehensive database managed by the National Institutes of Health (NIH).
• CenterWatch: A resource that offers details on current clinical trials across a wide range of medical conditions.

By participating in a clinical trial, patients with spinal fractures can not only gain access to new therapies but also contribute to medical research that may benefit future patients.

Immediate Response to Burst Fractures at Accident Scenes

When encountering a burst fracture at the scene of an accident, handling the patient appropriately is crucial to prevent further injury. Here are key steps on how to manage such patients effectively:

• Keep the Patient Flat: The patient must be laid down in a supine position (lying on their back). It is imperative to avoid placing them in a seated or bent posture, as this could exacerbate their condition.
• Avoid Unnecessary Movement: Minimize any movement to prevent increased neurological damage. The patient’s spine should be kept as immobile as possible during handling and transportation.
• Seek Expert Care Promptly: Immediate medical attention is necessary. Ensure the patient is transported to a hospital where a specialized orthopedic or neurosurgeon trained in spinal surgery is available.
• Conduct Necessary Scans: Once at the medical facility, obtaining X-rays is vital to assess the extent of the injury and plan further treatment.

By following these guidelines, the chances of aggravating a spinal injury at the scene can be significantly reduced, paving the way for effective medical intervention.

What Are the Potential Outcomes of Untreated Spinal Compression Fractures?

Untreated spinal compression fractures can have a range of significant outcomes that impact overall health and quality of life. These fractures commonly occur in the lower thoracic spine (middle back) and upper lumbar spine (lower back), areas that endure a lot of stress.

Potential Consequences Include:

• Chronic Pain: While some individuals might not feel any immediate discomfort, others can suffer from acute, debilitating pain. This pain can evolve into a chronic condition, severely affecting your daily activities.
• Height Loss: Over time, untreated fractures can cause a noticeable loss in height. This happens as the vertebrae compress and collapse, shortening the spine.
• Spinal Deformity: One of the most serious outcomes is the development of a stooped forward posture known as kyphosis or “dowager’s hump.” This deformity occurs when multiple untreated fractures lead to curvature of the spine.
• Reduced Mobility: As the spinal structure weakens, moving around may become increasingly difficult. This reduced mobility can limit your ability to perform everyday tasks and enjoy recreational activities.
• Respiratory Issues: Severe cases of kyphosis may compress the lungs and restrict breathing. This can lead to respiratory problems and decreased lung function over time.

Importance of Timely Treatment

Addressing spinal compression fractures early can prevent these outcomes and improve your quality of life. Consulting a healthcare provider for proper diagnosis and treatment is crucial. Options may include pain management, physical therapy, or surgical interventions, depending on the severity of the fractures.

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 does not cause nerve or structural damage, the doctor may choose a nonsurgical treatment.

Bracing to treat Vertebral Compression Fractures

Bracing plays a crucial role in managing vertebral compression fractures by providing much-needed support and stability to the spine. A well-designed brace tightly conforms to the body’s contours, similar to how a cast supports a broken limb. One of the primary functions of a spinal brace is to restrict forward movement. By doing so, it keeps the spine in what is known as hyperextension—a position where the spine is extended further than usual. This reduction in movement diminishes the pressure exerted on the fractured vertebra, facilitating natural healing.

Furthermore, bracing serves as a protective shield for the damaged vertebra. By preventing additional collapse or worsening of the fracture, ensures that the vertebrae remain stable throughout the recovery period. In summary, the use of a brace can significantly aid in the healing process while also guarding against further injury.

What Treatment Options Are Available for Spinal Compression Fractures?

When it comes to treating spinal compression fractures, there’s a wide range of options available, tailored to the severity of the injury and the patient’s overall health.

Non-Surgical Treatments

Rest and Activity Modification:

• Initial Rest: Rest is crucial immediately following the injury to reduce pain and prevent further damage. However, prolonged bed rest is not usually recommended.
• Activity Modification: Gradual return to normal activities is encouraged, avoiding high-impact tasks that could exacerbate the fracture.

Medication:

• Pain Relievers: Over-the-counter pain medications like acetaminophen or ibuprofen can help manage discomfort.
• Prescription Medications: For more severe pain, doctors may prescribe stronger pain relievers or muscle relaxants.

Bracing:

• Supportive Braces: Wearing a back brace can provide support to the spine, helping to stabilize the fracture and reduce pain during the healing process.

Physical Therapy:

• Rehabilitation Exercises: Physical therapy helps strengthen the muscles surrounding the spine, improving mobility and reducing further injury risk.

Surgical Treatments

Vertebroplasty and Kyphoplasty:

• In these minimally invasive procedures, a special type of cement is injected into the fractured vertebra to stabilize it and alleviate pain. Kyphoplasty includes the additional step of creating space in the vertebra with a balloon before the cement is injected.

Spinal Fusion:

• For severe fractures, spinal fusion may be necessary. This involves joining two or more vertebrae together to stabilize the spine, often using metal rods and screws.

Decompression Surgery:

• In cases where there is a risk of spinal cord compression, decompression surgery may be performed to relieve pressure on the spinal cord or nerves.

Consulting a Physician

Any patient exhibiting symptoms of a spinal compression fracture should promptly seek medical advice. A healthcare provider can offer a thorough evaluation, including imaging tests, to determine the most suitable treatment plan.

By considering these treatment modalities, patients and doctors can work together to create a comprehensive and effective management plan for spinal compression fractures.

Surgery

If the burst fracture weakens the spine or causes 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 in these procedures. Doctors use Implants, such as screws and rods, to keep the spine in place while the bones fuse.

Healing from vertebral fractures typically requires around three months. During this period, your doctor will likely schedule monthly X-rays to monitor how the bones are mending. This helps ensure that the healing process is on track and allows for any necessary adjustments in your treatment plan. Regular follow-ups are key to a full recovery.

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 follow standard procedures. However, several surgeons lately proposed using instrumentation without fusion.  This treatment and its outcomes have not yet been analyzed using a large population. Finally, regardless of treatment, the doctor’s goals remain the same — stabilizing the spine, preserving function, and restoring balance.

Choose the experts at the Southwest Scoliosis and Spine Institute

The Southwest Scoliosis and Spine Institute with offices in Dallas, Plano, and Frisco, Texas is a Premier Scoliosis Treatment Center.  We have top-rated, board-certified, fellowship-trained doctors who specialize in diagnosing and treating Scoliosis, Complex Spine Issues, and Spine Revision for both children and adults.

Finally, our doctors specialize in providing solutions even when other specialists claim nothing can be done.  Please note that we have successfully treated over 100,000 patients and carried out over 16,000 surgeries. We offer hope and deliver solutions.  Call us today.

____________________

Health Central: Burst Fracture