Spinal Fracture
A spinal fracture, also called a vertebral fracture, is a break in one or more of the bones (vertebrae) that make up the spinal column. These fractures can result from high-energy trauma such as motor vehicle accidents or falls, or from minimal trauma in cases of weakened bone due to osteoporosis, cancer, or infection. Spinal fractures range from mild compression fractures that may cause only pain to severe fracture-dislocations that can damage the spinal cord, causing paralysis. The type, location, and stability of the fracture determine treatment and prognosis.
What is it?
Each vertebra consists of a large cylindrical body in front, a ring-shaped arch in back that forms the spinal canal, and various bony projections. Spinal fractures are classified by mechanism, location, and stability. Common fracture types include compression fractures (most common, where the front of the vertebral body collapses while the back remains intact), burst fractures (the vertebral body is crushed in all directions with fragments potentially pushed into the spinal canal), flexion-distraction fractures (Chance fractures, where the spine is pulled apart due to forward flexion), and fracture-dislocations (severe injuries where bones break and ligaments tear, causing spinal instability). Fractures are also classified as stable (the spine can still bear weight without progressive deformity or neurological risk) or unstable (at risk for progressive deformity or spinal cord injury).
Spinal fractures have two main etiologies: traumatic fractures result from high-energy injuries such as motor vehicle accidents, falls from height, diving accidents, or direct blows, most commonly affecting younger individuals; pathologic or fragility fractures occur in weakened bone from minimal trauma or even routine activities, caused by osteoporosis (most common), cancer metastases, multiple myeloma, infection (osteomyelitis), or other bone-weakening conditions, primarily affecting older adults especially postmenopausal women. The thoracolumbar junction (T12-L1) is the most vulnerable region for traumatic fractures due to the transition from the rigid thoracic spine to the more mobile lumbar spine. Risk factors for osteoporotic fractures include advanced age, female gender, low bone density, previous fractures, corticosteroid use, smoking, excessive alcohol consumption, and inadequate calcium/vitamin D intake.
Important to Know
Symptoms of spinal fractures vary depending on severity and location. Compression fractures from osteoporosis may cause sudden onset of severe localized back pain that worsens with standing or walking and improves with lying down, height loss over time due to vertebral collapse, and progressive spinal deformity (kyphosis or “dowager’s hump”). Traumatic fractures typically cause immediate severe pain at the injury site, visible deformity or abnormal spine angulation, and inability to move or bear weight. Neurological symptoms indicating spinal cord or nerve involvement include weakness or paralysis below the fracture level, numbness or altered sensation, loss of bowel or bladder control, and breathing difficulties with high cervical fractures. Diagnosis begins with X-rays to identify fractures and assess alignment. CT scan provides detailed visualization of bone anatomy and fracture patterns, crucial for surgical planning. MRI is essential when neurological symptoms are present, to assess spinal cord compression, disc injury, and ligamentous damage, and to distinguish acute from old fractures and differentiate osteoporotic from pathologic fractures. Treatment depends on fracture type, stability, and presence of neurological injury. Stable compression fractures without neurological compromise are typically treated conservatively with pain management, activity modification, and bracing for 6-12 weeks. Vertebroplasty or kyphoplasty (minimally invasive procedures injecting bone cement) may be offered for painful osteoporotic fractures not responding to conservative care. Unstable fractures or those with neurological compromise require surgical stabilization with instrumentation and fusion to decompress neural structures and restore spinal alignment. Underlying conditions like osteoporosis require treatment with calcium, vitamin D, and anti-osteoporosis medications to prevent future fractures. Prognosis varies widely—stable fractures generally heal well with conservative treatment, while severe fractures with spinal cord injury may result in permanent neurological deficits despite optimal treatment.