Fracture of the Thoracic and Lumbar Spine
These articles are for general information only and are not medical advice. Full Disclaimer. All articles compliments of the AAOS
Fracture of one or more parts of the spinal column (vertebrae) of the middle (thoracic) or lower (lumbar) back is a serious injury usually caused by high-energy trauma like a car crash, fall, sports accident or act of violence (i.e., gunshot wound). Males experience the injury four times more often than females do. The spinal cord may be injured depending on the severity of the fracture. Symptoms include:
- Moderate to severe back pain made worse by movement.
- In some cases when the spinal cord is also involved, numbness, tingling, weakness or bowel/bladder dysfunction.
When you fracture the thoracic and lumbar spine, surgery or bracing is often necessary. Often, patients also have other life-threatening injuries. People with osteoporosis, tumors or other underlying conditions that weaken bone can get a spinal fracture with minimal trauma or normal activities of daily living.
Never attempt to move a person with a spinal injury, because movement can cause more damage. Call 911 immediately. Rescue workers know how to properly immobilize people with injuries and safely take you to the hospital for evaluation and treatment.
After checking heart rate, breathing and other vital signs, a doctor locates the fractured part(s) of the spine and determines the extent of damage. He or she finds out exactly how the vertebra broke (fracture pattern) and whether you have nerve (neural) injury and/or spinal instability.
The doctor considers what caused the injury, gives you a physical/neurological examination and takes X-rays to show inside the body.
Every detail you can recall about what caused the injury may help the doctor. Sometimes rescue workers or other witnesses can supply more information. Did an accident eject the patient from a vehicle? Was there windshield or steering column damage? Was the person using a lap and/or shoulder seat belt? Did an airbag deploy?
The doctor carefully removes your clothing and immobilizes the body with a spine board for complete physical examination. This may include checking for swelling, bruising and other signs of injury to the head, chest, abdomen and back; evaluating strength, motion and alignment of arms and legs; feeling for tenderness on each rib and along the entire length of the spine; testing the tone and sensation of rectal muscles; and other evaluations.
You may also need a neurologic examination. This may include tests of sensory (i.e., temperature, pain and pressure sensitivity), motor (i.e., muscle strength) and reflex (i.e., knee jerk) functions of the nervous system. If you have neurologic damage, certain tests can show whether you may recover some function (incomplete deficit) or not (complete deficit).
X-rays of the entire spine from multiple angles may be necessary to see bone alignment and check for damage to soft tissue. Sometimes you may also need CT (computed tomography) or MRI (magnetic resonance imaging) scans to help the doctor better visualize the injury.
Doctors classify fractures of the thoracic and lumbar spine based upon pattern of injury:
- Compression Fracture. While the front (anterior) of the vertebra breaks and loses height, the back (posterior) part of it does not. This type of fracture is usually stable and rarely associated with neurologic problems.
- Axial Burst Fracture. You lose height on both the front and back of the vertebra in this type of fracture, often caused by a fall from height in which you land on your feet.
- Flexion/Distraction (Chance) Fracture. The vertebra is literally pulled apart (distraction), such as in a head-on car crash in which the upper body is thrown forward while the pelvis is stabilized by a lap seat belt.
- Transverse Process Fracture. This type of fracture results from rotation or extreme sideways (lateral) bending and usually does not affect stability.
- Fracture-Dislocation. This is an unstable injury involving bone and/or soft tissue in which one vertebra may move off the adjacent one (displaced).
Treatment goals include protecting nerve function and restoring alignment and stability of the spine. The doctor determines the best treatment method based upon fracture type and other factors.
Doctors usually treat compression and some burst fractures without surgery. If you have a simple compression fracture, you may need to wear a hyperextension brace for sitting and standing activities for 6–12 weeks. You should walk and do other exercises while healing and may take medication for pain. If you have a transverse process fracture, you may need to wear a thoracolumbar corset along with doing an aerobic walking program.
Some injuries require more aggressive treatment. You may need steroids if the spinal cord is injured. You may need surgery if you have an unstable burst fracture, flexion-distraction injury or fracture-dislocation. Surgery realigns the spinal column and holds it together using metal plates and screws (internal fixation) and/or spinal fusion.