Injury blog: Spinal fracture
A spinal fracture can be a scary thing to experience and depending on the severity and location in the spinal column, can have devastating consequences. Cases vary in severity from mild to severe and most breaks occur in the mid or low spine regions. Fractures in the neck region are less common, yet carry the greatest risk for serious consequences. Vertebral fractures are commonly seen in people with osteoporosis (i.e. people with very low bone mineral density and a weakened bone structure). Many are what you call ‘silent’ where there are no symptoms at all. Others can cause significant disability and high levels of pain.
As mentioned previously, spinal fractures are common in people with osteoporosis. In these people, they may result from a direct trauma (i.e. a hit to the spine itself) or indirect trauma (i.e. stepping off a pavement where the jarring effect from the step leads to a fracture in a weakened spot along the spine).
In a person who does not have osteoporosis, the main causes of a spinal fracture include:
• Road traffic collisions
• Falling from a great height
• Sports injuries (more commonly contact sports)
• Acts of violence (i.e. stabbings or gunshot wounds)
Neck breaks, although less common, usually result from a direct trauma to the neck, like when falling on the head or neck from a height. This type of injury can be seen in rugby players where they get lifted into the air, flipped upside down and land awkwardly on their head or with their head tilted to the side.
Types of spinal fracture
Fractures of the spine can be classified in different ways. It is first useful to know the structure of a vertebral bone. If you look at the spine from side on, each vertebra is stacked nicely on top of one another. The front part of the vertebrae (i.e. the part that sits closest to the front of the body when viewed from the side) is called the vertebral body. Each vertebral body connects to the one above by a disc. Towards the back of the vertebrae are the small bony
projections (these are the bits you can easily feel if you run your finger down the middle of someone’s back), and other bony projections which form joints when they connect to the vertebrae above and below (named ‘facet’ joints). All of the abovementioned parts are joined in the middle by bony struts known as pedicles.
Fractures that affect the vertebral body at the front section of the vertebrae, or the pedicles in the middle are generally classified as ‘major’, because these structures play a pivotal role in the stability of the spinal column. There is also a greater chance of nerve damage with these types of fractures. Fractures of the bony projections are usually less serious as they play a less important role in stabilisation of the spine and you are less likely to contact nervous tissue with these types of fracture.
Fractures are also classified regarding stability. A ‘stable fracture’ is one where the spinal column is still able to function relatively well with minimal chance of serious nerve damage due to spinal deformity. An ‘unstable fracture’ is the term used when the risk of nerve injury and deformity of the spinal column is higher.
Some specific types of spinal fracture include:
• Compression: The vertebral body collapses due to excessive forces acting on it. A sub-type of compression fracture is a ‘wedge’’ fracture, where only the front part of the body collapses, leaving a distinctive wedge shape when viewed on an x-ray.
• Burst: The vertebrae are literally crushed with forces acting on it from above and below. These are potentially very serious due to the widespread movement of bone that occurs during the fracture.
• Flexion-distraction: Your body is suddenly thrown forward (i.e. like in a car accident), and the force from high-speed movement leads to a break in the bony structure.
• Fracture-dislocation: This is the name given to any fracture where there is also significant movement or ‘dislocation’ of the bone from its normal resting place. These are severe fractures and have a high chance of associated nerve damage.
Signs and symptoms
The following signs and symptoms may be experienced following a spinal fracture. These completely depend on the severity of the fracture itself:
• Pain (with and without movement)
• Restriction of movement
• Nerve injury-related symptoms: Pins and needles, numbness, weakness (in the limbs) or possibly more severe symptoms such as changes in bowel and bladder function.
• Other-related injuries, such as head or brain injuries
The treatment of a vertebral fracture depends on the severity. We as chiropractors tend not to see severe cases in the early stages. Severe, unstable fractures will usually be dealt with in a hospital setting where stabilisation of the spine can occur and reducing the risk of spinal cord or nerve injury is the top priority. Once the spine is stable and healing of the fracture has occurred, we may then see these types of cases present to the clinic for rehabilitation. Otherwise, we usually see milder cases of fracture where hands-on techniques and rehabilitative exercises are warranted sooner.
If you or someone you know has fractured their spine and are keen to get back to former glory, then please call us today on 0413 774 399 to arrange an appointment.