Falls or trauma can cause spinal fractures. Although some of these injuries do not require surgery, large fractures should be treated promptly and appropriately. Delaying treatment in severe spinal fractures can cause serious long-term problems.
Fractures or dislocations due to minor accidents and traumas are frequently seen in patients with osteoporosis. Osteoporosis or weakening of the bones can cause serious injuries even in simple accidents.
Spinal fractures can lead to extremely serious consequences as they affect the nerve structures passing through the spine and the vital vessels and organs around it. 70% of spinal fractures occur in the thoracic and lumbar vertebrae, 5-10% in the cervical vertebrae, the rest in other parts of the spine.
In partial paralysis, especially when it is determined that the paralysis is progressive, surgery is absolutely and urgently required. In most of these patients, complete or almost complete recovery can be achieved.
Spine and Spinal Cord Anatomy
Let's briefly review the anatomy of the spine to understand the spinal fractures a little better. The spine consists of 33 bones called vertebrae, which are connected to each other by soft tissue, joints and intervertebral tissue (disc).
This chain of vertebrae forms a support structure that allows our body to stand upright and to move in all directions (bending forward, backward, turning to the sides). In addition, at the back of each vertebra there is a ring of bone structure through which the spinal cord passes, and these bone surround and protect the spinal cord.
The spinal cord consists of nerve tissue that provides the connection between the brain and the rest of the body including arms, trunk and legs. Spinal cord carries orders from the brain to these regions. By acting just like an electrical cable; Spinal cord enables movement of our hands, arms, feet and legs, and also carries out the sensory functions of our body to work properly. It also helps us breathe, controls urine and stool functions.
What Are Spinal Injuries?
Spinal injuries can range from mild soft tissue trauma to spinal fracture and spinal cord injury. Spinal fractures and dislocations can cause spinal cord injury and thus paralysis. The treatment of spinal injuries also varies according to the severity of the injury.
Where Do Spinal Fractures Occur?
5-10% of fractures occur in the cervical vertebrae, 70% in the thoracic and lumbar vertebrae, and the remainder in the other regions. The most frequently injured area is the 12th thoracic vertebra and the 1st lumbar vertebra, where the thoracic and lumbar vertebrae meet, in the most mobile region of the spine.
When a force, such as a fall or impact, is experienced by the spine, the bone tissue in the spine may not be able to carry the load. This can cause the spine to be compressed and fractured. If the compression is light, you will only experience mild pain and minimal deformation.
It usually occurs after high-energy traumas (traffic accident, falling from a height, jumping, etc.). There is also a special type of spinal fracture which occurs as a consequence of osteoporosis. These fractures, which can occur during even in normal daily activities, develop due to bone weakness (osteoporosis), this is seen more commonly in older ages.
If the trauma affecting the spinal cord or nerve roots is severe, pain may be experienced. This can cause kyphosis after a while. Osteoporosis is among the most common risk factors for spinal fractures, as the disease causes weakening of the bones.
Spinal Fractures may develop due to the following reasons:
- Accidents such as falls
- Sports accidents
- Spinal tumors
What Are the Causes of Spinal Fractures?
Spinal fractures usually develop due to high-energy trauma. Traffic accidents are known as one of the most common causes. Apart from this, falls (especially falls from height), gunshot injuries and sports accidents are among the main causes of spinal fractures. In the elderly with osteoporosis and in patients with spinal tumors, severe fractures may occur even after low-energy traumas such as minor falls, as the spinal bones affected by these diseases weaken.
Who Is Most Affected by Spine Fractures?
80% of patients with spinal fractures are between the ages of 18-50. Men are 4 times more likely to suffer a spinal fracture than women.
What Are the Symptoms of Spinal Fractures?
Early symptoms of spinal fractures vary according to the severity and location of the injury. Neck, back and low back pain and muscle spasms are the main findings. If there is a spinal cord injury, there may be various complaints such as numbness in the arms and legs, loss of strength, incontinence or inability to pass urine.
In the late period, if necessary treatment is not provided for patients without nerve injury, the most common complaint is the formation of humpback (kyphosis) in the spine and the severe pain it may cause. Patients with nerve injuries on the other hand, may suffer from paralysis and the problems it brings.
The primary and most important symptom is pain. Every patient who has suffered a trauma and presented with the complaint of pain in any part of the spine, without exception, is considered as a severe spinal trauma until proven otherwise.
Symptoms of a spinal fracture can vary depending on the severity of the injury. The following symptoms can be seen in spinal fractures;
- Back or neck pain
- Numbness, tingling, muscle spasms
- Changes in the intestines or bladder
If symptoms such as loss of movement in the arms or legs are observed, a doctor should be consulted as soon as possible.
In spinal injuries, it is extremely important to make the patient lie down without moving too much and to inform the ambulance as soon as possible. If the doctor suspects spinal fractures, he may request radiography, computed tomography, and MR images to make the definitive diagnosis of the patient.
How Is the Diagnosis Made in Spinal Fractures?
In cases of spinal injury, it is very important to transport the person to the nearest hospital. Ambulance and expert paramedics should be waited for the transportation.
Failure to carry the patient in an appropriate position is one of the most important factors affecting the fate of the injury. After being brought to the emergency room, doctors may request the following tests to make the diagnosis by performing the first intervention and examination.
It is the first examination to be performed on patients with suspected injury, often it can successfully reveal whether there is an injury.
It shows fractures better than direct radiography. It is routinely practiced in some hospitals. In other cases, it may be requested to evaluate the severity and type of fractures seen on direct radiography.
Magnetic Resonance Imaging (MR)
It is one of the best methods for evaluating the spinal cord and soft tissue lesions. It is not necessary for every patient, but may be requested in patients with fractures to assess the severity of the fracture and the condition of the surrounding soft tissues.
It may also be requested in cases of unexplained spinal cord injuries or in cases where the levels of spinal cord injury and spinal fracture do not match.
How Does a Spinal Cord Injury Occur?
Spinal cord injuries usually occur after spinal fractures, when the broken bone narrows the canal through which the spinal cord passes. However, it can also occur with excessive stretching of the spinal cord without any bone fracture, especially in children. Spinal fractures and injuries can occur in any part of the spine from the neck to the coccyx.
Different Mechanisms of Spinal Fractures?
If more load is placed on a bone than it can withstand, the bone will break. The most common type of fracture is "compression fractures", in which the anterior portion of the vertebrae collapses. If the load on the spine is even more excessive, then the middle and posterior parts of the vertebrae may also be broken and the broken pieces may displace towards the spinal canal and injure the spinal cord.
This type of fracture is called a "blast fracture". Although spinal cord injury and paralysis are common in blast fractures, not every blast fracture causes paralysis or spinal cord injury. Fractures are usually in a single vertebra, but may involve 20% or 30% of multiple vertebrae, either consecutively or non-consecutively.
Dislocations and Fracture-Dislocation
If the load on the spine increases even more, then with the fracture of the bone, injury of the soft tissues that connect the vertebrae and hold them together also occurs. Injury to discs, ligaments and joints may also be experienced. In this case, the two vertebrae are disconnected from each other and spinal dislocation may occur.
While spinal dislocation is rarely seen as a dislocation caused by injury to soft tissues, it is often seen as a "fractured dislocation" together with a vertebral fracture. With these two types of injury, spinal cord injury often develops and becomes one of the most dangerous forms of injury.
At the same time, dislocations and fracture-dislocations are much more difficult to heal than injuries with only fractures. For these reasons, dislocations or fractured dislocations often require surgical intervention.
First of all, a specialist physician determines whether the spine can carry the load-bearing function and whether there is a nerve injury. Pain treatment is the main approach in patients who do not present with neurological injury and are thought to have no problem in the load bearing capacity of the spine (stable).
Depending on the situation, limited periods of bed rest and restraint corsets may be recommended. However, if the integrity of the spine has been impaired due to fracture and it has become unable to carry out its load-bearing function (stable), and especially if there is partial or complete paralysis, surgical treatment is definitely applied (with some minor exceptions).
Corset or Plaster Treatment
A fixation is necessary for the healing of fractures. Corset or plaster treatment is preferred especially in compression fractures, in patients without spinal cord injury and soft connective tissue injury.
The aim is to heal the fracture with external fixation, to prevent the spine from collapsing further and putting pressure on the spinal cord and the development of humpback. The plaster or corset period is approximately 3 months.
Instrumentation and Fusion
It is the fixation and stabilization of the broken spine using metal tools. This process can be done from the front or back of the spine, sometimes both sides need to be stabilized, while the fusion process can take months.
At the same time, bone fragments compressing the spinal cord in patients with spinal cord injury should be removed during surgery. It is the treatment method of choice in burst fractures in which posterior connective tissues are injured, and in all other burst fractures or fracture dislocations with neurological injury.
Vertebroplasty & Kyphoplasty
It is a minimally invasive treatment method that can be applied in some selected compression fractures, osteoporosis or tumor-related fractures, and some burst fractures. It can be applied under local anesthesia. It is based on the principle of placing titanium cage-cement in order to fix and strengthen the fractured bone.
In this method, the aim is to remove the nerve damage. For this, other tissues such as bones, ligaments and discs that press on the nerve tissues are removed. A stabilization application that always provides fixation may also be required. This practice can positively affect nerve recovery and increase the likelihood of recovery from strokes. However, although not all paralysis is completely cured by surgery, it can increase the recovery rate in some cases.
Screws and rods are often used to fix fractures in the spine. This application allows patients to be able to move in a shorter period of time and to start rehabilitation therapies.
If the patients do not have additional injuries, abdominal and lung problems, the rehabilitation process can be started from the 4th day after surgery. Even if there is an improvement of the nerve injury or improvement of the paralysis after the surgery, this process will take months, so patients should start rehabilitation as soon as possible instead of waiting for recovery.
The recovery process after spinal fracture surgery goes like this:
The patient is mobilized in a controlled manner by standing up the next day of the surgery.
The patient can be discharged on the 3rd or 4th day.
After the 3rd week, the patient can go out of the house with supervision.
After the 4th week, the patient can go to school in a controlled manner and do light body exercises (pilates band, light weights). The patient can walk unlimitedly, swim in the pool or in the sea to cool off.
From the end of the 2nd month, the patient can use public transport (including school bus).
From the end of the 3rd month, the patient can continue their normal daily life without restrictions (except for heavy sports), and can do light individual jogging and swimming for sports purposes.
As of the end of the 6th month, the patient can do running and other individual sports (racquet sports, etc., not for competition purposes) and can ride bicycle.
After the first year, following the last routine control, the patient is free to do anything except for combat sports and especially dangerous activities (parachute, bungee jumping, etc.).