Spinal trauma and fractures 

What is a spinal fracture?

A spinal fracture is a clinical term used to describe the breaking and/or dislocation of any of the group of small bones in your back, known as the vertebrae. Your spinal column consists of 33 vertebra, all of which protect the spinal cord, support the weight of your head and body, and allow flexible movement.

The severity and consequences of a fractured spine can vary significantly depending on the type of fracture, the spinal segment impacted, and if any damage has been done to the spinal cord. Less severe cases can be treated often without the need for surgery.

The significance of the spinal cord, which runs through the spinal canal of each vertebra, makes the potential consequences of any break or fracture serious. Your spinal cord is a long tube of tissue containing nerves and cells and is primarily responsible for your motor function (how you move, sense and react). It connects your brain to your lower back through the nervous system. A vertebral fracture or dislocation can pinch, compress and even tear your spinal cord and nerves, so always seek expert medical attention and spinal fracture treatment as soon as possible.

What causes spinal fractures?

Anyone can suffer a fractured spine, just like any bone fracture or break. They're most commonly caused by traumatic events such as traffic collisions, sports injuries and falls from a height, all of which exert significant forces on your body and musculoskeletal system. The spine and vertebrae are flexible and can usually withstand the impacts of daily life, but the sudden and often extreme forces involved in a traumatic event can overload your spinal column. This can cause single or multiple fractures along your backbone. Dislocations can be independent of or connected to fractures and occur when the discs or ligaments connecting two vertebra are torn or stretched.

However, traumatic events aren't the only cause of spinal fractures. Other health conditions can leave your vertebrae more susceptible to breaks due to deteriorating bone density and strength over time. The most common include:

• Osteoporosis: This condition weakens your bones and makes them more likely to break or fracture. Older adults are more likely to develop osteoporosis as they age, but it can impact younger people too.
• Cancer and spinal tumours: Spinal cancer or one that has spread to the area from another part of the body (metastasic cancer) can contribute to vertebral fractures. As tumours grow, they often put pressure on the spinal cord, increasing the risk of fractures. Spinal tumours can also be non-cancerous but just as threatening to your health and mobility.

Types of spinal fractures 

Different types of fractures can develop in any of the vertebra along your spine, while dislocations occur between vertebra. Identifying which type of spinal fracture you've suffered allows consultants to assess the injury's severity, evaluate the risks and suggest the most effective treatment.

Fracture location

Your spinal column consists of three different sections, as well as five sacral and four coccyx bones which make up the rest of the 33 vertebrae. A spinal fracture can occur in any of the segments, including:

• Cervical spine: The top seven vertebrae make up your cervical spine segment, closest to the base of your skull and neck
• Thoracic spine: The middle 12 vertebrae are in the thoracic spine segment, which runs from the base of your neck to the bottom of your ribs.
• Lumbar spine: The bottom five vertebrae are the largest in the spine and form your lumbar segment, which supports much of your body weight in the lower back.

Fracture types

As well as the location, the type of fracture can determine the severity of a spine injury. The most common include:

• Compression fractures: Small cracks and deterioration of the vertebrae can lead to collapse under sustained compression over time. This impacts the front of the vertebrae more than the back, often creating a hunched posture and reducing your height. This type of spinal fracture is most common in people with osteoporosis but can occur after tumours. 
• Burst fractures: These injuries are more sudden and usually happen when your spine is compressed under significant weight or force. This often leads to your vertebrae breaking into many pieces and in multiple directions, increasing the chances of spinal cord damage. This is typically a more severe and debilitating spinal fracture, commonly arising from traffic collisions and sports injuries.
• Chance (distraction) fractures: Like a burst injury, a chance fracture also occurs suddenly but when extreme forces pull vertebra away from each other rather than compressing them. These are sometimes referred to as seatbelt fractures because the rapid deceleration in a car crash can cause your spine to flex beyond its limits. 

Stable and unstable spinal fractures

There's an important distinction to be made between stable and unstable spinal fractures. Your consultant will use this as another way to classify and assess your injuries, as well as to recommend the most effective treatment for your condition.

A stable fracture is less serious because the structure of your spinal column hasn't been fundamentally changed, despite a fracture somewhere along the vertebrae. You'll still need treatment, but the need for spine surgery is less likely.

An unstable fracture carries greater risk because the vertebrae has been dislodged from its natural alignment and poses a greater threat to your spinal cord and the structure of your backbone. Spine surgery is more likely to be needed for an unstable fracture because the damage is more severe and the ongoing risks of nerve damage and paralysis are higher.

How is a fractured spine diagnosed?

During an appointment with a specialist consultant, you'll be asked to share your symptoms and discuss any changes you've noticed in your posture, strength or mobility. They'll also ask you about any pain or nerve damage symptoms you're experiencing. A physical examination may help to reveal key areas of your spine to focus on, but imaging tests are usually needed to confirm a spinal fracture.

If you have osteoporosis or recently experienced trauma (for example, in a car accident), this information will help the consultant get a better sense of the cause behind your spinal fracture pain. If you were taken into emergency care after a traumatic accident, a fractured spine may have been diagnosed by medical staff there and then.

The imaging tests most commonly used to diagnose spinal fractures are X-rays, MRI scans and CT scans. You may also need a bone density (DEXA) scan if you're at risk of osteoporosis. One or a combination of these tests will allow your consultant to assess the severity and type of fracture you've suffered, before recommending the most effective spinal fracture treatment.

Spinal fracture treatments

The most effective treatment for a spinal fracture depends on what caused it, which type you've suffered and where along your backbone the fracture occurred. The more severe your spine injury or trauma, the higher the likelihood you'll need surgery.

Non-surgical treatments

Many less severe spinal fractures don't require surgery and can heal naturally over time. The most common treatments to aid this process are:

• Pain management: Taking over-the-counter anti-inflammatory drugs is often used to manage the pain and symptoms of a spinal fracture until other treatment is provided or while treatment is ongoing. However, this shouldn't be a long-term approach and you should seek medical diagnosis and treatment if you haven't already
• Back bracing: A supportive back brace can help maintain proper spinal alignment and immobilises your spine to avoid further damage to your vertebrae and promote healing. This may be needed for 8-12 weeks, but your consultant will discuss details about the type of brace and how long you'll wear it. Different braces are needed for different sections of your spine, as well as for unstable and stable fractures.
• Physical therapy: In cases where bone density and strength continue to pose a risk to your spinal column, physical therapy may be recommended to reduce the risk of spinal fractures reoccurring. The aim is to strengthen the muscles, ligaments and tendons in your back to provide more support to the spine.
• Medicine or supplements for the underlying issue: If certain health conditions have caused or increased your risk of a spinal fracture, consultants will recommend medicine or supplements to help with underlying issues. For example, if you have osteoporosis, you may be given supplements to maintain and improve your bone density to reduce the risk of fractures in the future. 

Fractured spine surgery

Surgery may be required for more serious cases, particularly where there's a risk of damaging your spinal cord. For osteoporotic compression fractures, the two most common spinal surgeries are:

• Vertebroplasty: A small cut is made to allow a hollow needle to access the fracture, then liquid bone cement is injected into the collapsed vertebra to stabilise them. 
• Kyphoplasty: A small cut is made in the affected area and a balloon is inserted into the collapsed vertebra and inflated to restore height and position. This creates a cavity that is filled with liquid bone cement under pressure to correct the anatomy of the fractured bone while improving strength and stability.

Both kyphoplasty and vertebroplasty are minimally invasive surgeries to reduce tissue damage, blood loss and operating times. Your consultant will explain the procedure beforehand, including whether you'll be under general or local anaesthetic. After the surgery, you may need to lie flat for a few hours, but you should be able to go home on the same day. The cuts should heal within a week but you'll have to avoid intense exercise or heavy lifting for up to six weeks.

For unstable and more severe burst or chance fractures, minimally invasive procedures may not be suitable. This is because of the damage caused by your injuries and the pressing risk to your spinal cord. Your spinal surgery consultant may recommend a more conventional open operation instead. 

This may involve the fusion of vertebrae, where two bones are held together with a bone graft using plates, rods and screws. This should restore spinal stability by creating one connected piece of bone, although this can take several months to years to fuse sufficiently.

If your fracture was caused by a cancerous or benign spinal tumour, you may need initial treatment to remove it before other treatment can take place.