Mark W. McFarland, DO
The phrases that conjure up the worst-case trauma scenarios are “someone’s going to break their neck” or “step on a crack, break your mama’s back”. We can all recall images of TV shows of long ago, with hospital scenes of some unfortunate patient with a “broken” neck or back, lying in bed, usually in a halo-traction device or a ridiculous body cast, surrounded by handwringing loved ones. Thankfully, a skilled, but more importantly, incredibly handsome surgeon, sweeps into the hospital (in the nick of time, mind you) and prevents the patient from being paralyzed after a successful, but vague, spine operation.
So, what’s the deal with vertebral fractures anyway, and are they really that big of an emergency? In this article, I will discuss the types of fractures seen in the spinal bones and how they are identified.
Most fractures of the spine occur either in the thoracic (mid-back) spine or the lumbar (lower back) spine, not in the cervical (neck) spine. The neck is extremely flexible and can bend and twist in a myriad of ways. During an accident or trauma, that flexibility helps the neck bones take a lot of force without breaking. However, the thoracic and lumbar spine are not that flexible and carry much more of the body’s weight. When traumatic force is applied, these bones tend to fracture more easily.
Here are the types of spinal bone fractures – unstable refers to the need for surgical intervention to stabilize the bones to prevent further injury/nerve damage:
Compression fracture – this fracture type is often seen in osteoporotic older women and is usually stable. More rarely, it can be seen in people who have fallen from heights or have been crushed under debris, as in an earthquake.
Axial Burst fracture – in this type, the front and back of the vertebrae are compressed and there can be nerve damage. This fracture can be either stable or unstable, requiring surgical intervention. This is often seen after a fall from height where the person lands on his/her feet.
Fracture-Dislocation – This occurs when one vertebra is moved with force off the top of the adjacent vertebra, often causing significant compression/damage to the spinal cord. Most often, this is an unstable fracture needing immediate surgical intervention.
Flexion/Distraction fracture – also known as a Chance fracture, this type often occurs in a head-on car crash where the occupant is held in place by a lap belt and thrown forward. The vertebrae are pulled apart by the force of the collision and this fracture is considered unstable, warranting surgery.
Transverse process fracture – this is the most uncommon of the fracture types and occurs with extreme side bending or twisting/rotating force. These fractures are typically stable.
Some of these fractures can be life-threatening and surgical treatment may have to be timed with other emergency surgeries to save the trauma patient’s life. Others aren’t so concerning and can be treated with an in-office procedure that will have the patient walking and pain-free in an hour or so. Some may simply require bracing, rest and activity modification for a few weeks. Stay tuned for upcoming articles where we’ll discuss each of these fracture types in detail, specific treatments, recovery, and rehabilitation expectations.