Spinal Fracture

Medically Reviewed By William C. Lloyd III, MD, FACS
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What is a spinal fracture?

A spinal fracture is a broken vertebra in the back, which can occur in the cervical spine in the neck but most often happens in the thoracic (middle back) or lumbar (lower back) spine—the thoracolumbar spine. There are several types of vertebral fractures: compression fracture, burst fracture, chance fracture (also called a flexion/distraction fracture), and fracture-dislocation. These range in severity from a cracked vertebra to vertebral displacement and spinal cord compression, which can cause paralysis without immediate treatment.

Spinal compression fractures occur more frequently in older women than other populations because they have higher rates of osteoporosis—the most significant risk factor for compression fractures—compared to same-aged men. Traumatic causes of a fractured back include car crashes and falls. These types of injuries are more frequent in men younger than 30 years old.

Pain at the site of the fractured vertebra is common. If your spinal cord was also injured, you could also experience neurological symptoms like numbness, tingling or weakness in the arms or legs. The specific symptoms depend on where the fracture occurred along the spinal column and the severity of the fracture.

Treatment also depends on the severity and location of the spinal fracture. Cracked vertebrae can often be treated with pain relievers, rest, and physical therapy. Severe spinal injuries may require immediate surgery to prevent permanent disability. Without proper care, a spinal fracture that has injured the spinal cord can cause loss of bladder and bowel control as well as paralysis.

In case of injury and possible spinal fracture, call 911 for emergency medical care. Do not try to move the person on your own unless you have to. Emergency medical personnel will move the person with special equipment designed to stabilize the spine.

What are the symptoms of a spinal fracture?

The most common symptom of any spinal fracture is pain, which typically gets worse with movement. For any fracture that causes spinal cord compression, spinal fracture symptoms can also include muscle spasms, numbness, weakness, tingling sensation, and paralysis.

Spinal fractures can be stable or unstable. Stable spinal fractures involve the front half of the spinal column, not involving the stabilizing facet joints. There is no neurological damage and the spine can still function and support body weight. An unstable fracture involves injuries to either or both the middle and posterior columns—including the back side of the bony vertebra and facet joints.

In the case of an unstable spinal fracture, there can be spinal deformity and signs of significant neurological damage—the person might also experience bladder or bowel incontinence or a loss of consciousness. A traumatic injury can cause other injuries that overwhelm the pain of the spinal fracture. These are called distracting injuries, and they may cause the person not to realize pain from a broken back. Always seek emergency care (call 911) for a suspected spinal fracture with or without nerve symptoms.

What causes a spinal fracture?

Osteoporosis or any other condition that weakens the bones is the most common cause of a compression fracture. These fractures are usually stable—when the front of a vertebra breaks but the back of the bone is intact. This is also called a wedge fracture because it looks like a wedge from the side view. Something as minor as bending over or twisting can cause a spinal compression fracture in a person with thinning bones.

Traumatic spinal fractures can occur after a significant force is directed on the spine, such as forceful twisting or direct impact. Causes include motor vehicle crashes, falls from a significant height, sports-related accidents, and acts of violence, such as a gunshot wound. These are often more serious breaks, such as dislocation of the backbone or crushing injuries to one or more vertebrae.

What are the risk factors for spinal fracture?

Osteoporosis is the main risk factor for compression fractures. Other conditions that can weaken bones and cause compression fractures include metastatic cancer that has spread to the spine and primary bone cancers.

Risk factors for burst, chance, and fracture-dislocation spinal fractures include:

  • Being in a car or motor vehicle crash

  • Participating in activities, sports and occupations with a risk of traumatic injury and/or falling from a height

  • Male gender from 16 to 25 years old; this population is more likely to suffer a traumatic injury resulting in a spinal fracture

Reducing your risk of spinal fracture

You may be able to lower your chance of getting a spinal fracture by:

  • Getting regular physical exercise to strengthen your bones and back muscles, which provides more stability to your spine

  • Getting enough calcium and vitamin D to prevent or slow osteoporosis development

  • Using protective gear and correct technique during sporting activities

  • Reducing your risk of falls, either by not engaging in the activity or by tethering yourself correctly

How is a spinal fracture treated?

Spinal fracture treatment depends on the type and severity of the break as well as whether the spinal cord was damaged. Doctors also consider any other injuries that occur with the fractured vertebrae when determining the appropriate treatment.

Nonsurgical treatment

Nonsurgical treatment is usually recommended for spinal compression fractures and stable burst fractures, which occur when both the front and back side of the vertebra breaks. A flexion/distraction fracture, also called a chance fracture, is a type of extension fracture in which a vertebra is pulled apart. These breaks are usually treated without surgery if the doctor can stabilize the spine with a brace or cast and if the posterior ligaments weren’t damaged.

Nonsurgical treatments include pain relievers and a brace, cast or collar to immobilize your spine and maintain proper alignment while the fracture heals. Spinal fracture recovery time is usually 6 to 12 weeks in a brace, depending on the severity of the break. Physical therapy for 1 to 2 months after the brace is removed will help you return to your normal activities.

Surgical treatment

More severe spinal fractures may require surgery to stabilize the spinal column and prevent permanent disability. Surgery is often needed to treat unstable burst fractures that result in several bone fragments or nerve damage from a pinched spinal cord. A flexion/distraction fracture with damaged posterior ligaments of the spine will often need surgery. Fracture-dislocation injuries almost always require surgery because they are usually very unstable breaks involving the spinal cord.  

The goal of surgical treatments is to stabilize the fracture and relieve any pressure on the spinal cord. A spine surgeon—either an orthopedic surgeon or neurosurgeon—will remove bones causing spinal cord compression. The surgeon may use a bone graft with metal hardware to fuse two (or more) vertebrae together and ensure the fracture is stable so it can heal properly.

What are the potential complications of a spinal fracture?

Our spine is what allows us to move freely. A minor spinal fracture may not cause any long-term damage, but chronic pain and disability are possible. More significant fractures can lead to spinal deformity, chronic pain, and loss of mobility. Spinal nerve compression and spinal cord injury can introduce other complications like loss of sensation and paralysis.

Although the benefits of spinal fracture treatment usually far outweigh the risks, there are potential complications with spine surgery. Risks include bleeding, blood clots, infection and reaction to anesthesia. Other complications from spinal surgery include leaking of spinal fluid as well as nonunion, which is when that the fracture doesn’t heal properly even after the surgery.

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Medical Reviewer: William C. Lloyd III, MD, FACS
Last Review Date: 2020 Aug 23
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