Project Description

Fractures of the thoracic and lumbar spine may result from high-energy trauma, such as a:

  • Car or motorcycle crash
  • Fall from height
  • Sports accident
  • Violent act, such as a gunshot wound

Many times, these patients have additional serious injuries that require rapid treatment. The spinal cord may also be injured, depending on the severity of the fracture.

Spinal fractures may also be caused by bone insufficiency. For example, people with osteoporosis, tumors, or other underlying conditions that weaken the bone can fracture a vertebra even during low-impact activities–such as reaching or twisting. These fractures may develop unnoticed over a period of time, with no symptoms or discomfort until a bone breaks.

There are different types of spinal fractures. Doctors classify fractures of the thoracic and lumbar spine based upon the specific pattern of the fracture and whether there is a spinal cord injury. Classifying the fracture pattern will help your doctor determine the proper treatment.

The three major types of spine fracture patterns are:

  • Flexion
  • Extension
  • Rotation

When a bone in the spine collapses, it is called a vertebral compression fracture. These fractures happen most commonly in the thoracic spine (the middle portion of the spine), particularly in the lower vertebra of the thoracic spine.

Symptoms

If the fracture is caused by a sudden, forceful injury, you will probably feel severe pain in your back, legs, and arms. You might also feel weakness or numbness in these areas if the fracture injures the nerves of the spine. If the bone collapse is gradual – such as a fracture from bone thinning, the pain will usually be milder. There might not be any pain at all until the bone actually breaks.

Diagnosis

In order for a fracture to be diagnosed, you will need to visit a health care provider. Before your doctor can diagnose your condition and design a treatment plan, a complete history and physical examination are necessary. There are many possible internal causes of pain. It is important to determine what is and is not the root of the problem. After the physician has a better idea of what is causing your discomfort, diagnostic tests of some sort may be recommended.

Physical Examination

The emergency room doctor will conduct a thorough evaluation, beginning with a head-to-toe physical examination of the patient. This will include an inspection of the head, chest, abdomen, pelvis, limbs, and spine.

Tests

Neurological tests. The doctor will also evaluate the patient’s neurological status. This includes testing his or her ability to move, feel, and sense the position of all the limbs. In addition, the doctor will test the patient’s reflexes to help determine whether there has been an injury to the spinal cord or individual nerves.

Imaging tests. After the physical examination, a radiologic evaluation is required. Depending on the extent of injuries, this may include x-rays, computed tomography (CT) scans, and magnetic resonance imaging (MRI) scans of multiple areas, including the thoracic and lumbar spine.

Treatment

Treatment for a fracture of the thoracic or lumbar spine will depend on:

  • Other injuries and their treatment
  • The particular fracture pattern

Once the trauma team has stabilized all other life-threatening injuries, the doctor will evaluate the spinal fracture pattern and decide whether spine surgery is needed.

Nonsurgical treatment. Most flexion injuries–including stable burst fractures and osteoporotic compression fractures—can be treated with bracing for 6 to 12 weeks. By gradually increasing physical activity and doing rehabilitation exercises, most patients avoid post-injury problems.

Surgical treatment. Surgery is typically required for unstable burst fractures that have:

  • Significant comminution (multiple bone fragments)
  • Severe loss of vertebral body height
  • Excessive forward bending or angulation at the injury site
  • Significant nerve injury due to parts of the vertebral body or disk pinching the spinal cord

References

http://orthoinfo.aaos.org/topic.cfm?topic=a00368

http://umm.edu/programs/spine/health/guides/thoracic-compression-fractures

http://umm.edu/programs/spine/health/guides/diagnostic-tests