Fracture Vertebrae

8/12/2019 Fracture Vertebrae

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Fractures of the Thoracic and Lumbar SpineA spinal fracture is a serious injury.The most common fractures of the spine occur in the thoracic (midback) and lumbar spine (lower back) or

at the connection of the two (thoracolumbar junction). These fractures are typically caused by high-velocity

accidents, such as a car crash or fall from height.Men experience fractures of the thoracic or lumbar spine four times more often than women. Seniors are al

so at risk for these fractures, due to weakened bone from osteoporosis.Because of the energy required to cause these spinal fractures, patients often have additional injuries that

require treatment. The spinal cord may be injured, depending on the severity of the spinal fracture.Understanding how your spine works will help you to understand spinal fractures. Learn more about your spine:Spine BasicsCauseFractures of the thoracic and lumbar spine are usually caused by high-energy trauma, such as: Car crash Fall from height Sports accident Violent act, such as a gunshot woundSpinal fractures are not always caused by trauma. For example, people with osteoporosis, tumors, or otherunderlying conditions that weaken bone can fracture a vertebra during normal, daily activities.Top of pageTypes of Spinal FracturesThere are different types of spinal fractures. Doctors classify fractures of the thoracic and lumbar spine based upon pattern of injury and whether there is a spinal cord injury. Classifying the fracture patterns can hel

p to determine the proper treatment. The three major types of spine fracture patterns are flexion, extension, and rotation.

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SymptomsThe primary symptom is moderate to severe back pain that is made worse by movement.When the spinal cord is also involved, numbness, tingling, weakness, or bowel/bladder dysfunction may oc

Rotation Fractu re PatternTransverse process fracture.This fracture is uncommon and results from rotation or extreme sideways (lateral) bending, andot affect stability.Fracture-dislocation.This is an unstable injury involving bone and/or soft tissue in which a vertebra may move off an adjacenaced). These injuries frequently cause serious spinal cord compression.

Extens ion Fracture PatternFlexion/distraction (Chance) fracture.The vertebra is literally pulled apart (distraction). This can happen in accidents such a

Flexion Fractu re PatternCompression fracture.While the front (anterior) of the vertebra breaks and loses height, the back (posterior) part of it does nracture is usually stable and rarely associated with neurologic problems.Axial burst fracture.The vertebra loses height on both the front and back sides. It is often caused by a fall from a height and l
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cur.In the case of a high-energy trauma, the patient may have a brain injury and may have lost consciousness,or "blacked-out." There may also be other injuries called distracting injuries which cause pain that ov

erwhelms the back pain. In these cases, it has to be assumed that the patient has a fracture of the spine, especially after a high-energy injury (motor vehicle crash).Top of pageExamination

Top of pageTreatmentThe treatment plan for a fracture of the thoracic or lumbar spine will depend on: Other injuries and their treatment The particular fracture patternOnce 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.

Flexion Fractu re PatternNonsurgical treatment.Most flexion injuries (compression fractures, burst fractures) can be treated in a brace for 6 to 12 weey 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 (fracture 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 cordThese fractures should be treated surgically with decompression of the spinal canal and stabilization of the fracture. Decompreoving the bone or other structures that are pressing on the spinal cord. This procedure is also called a laminectomy.To perform the decompression, your surgeon may decide to access your spine with an incision either on your side or on your bh allows for safe removal of the structures compressing the spinal cord, while preventing further injury.

Investigatio n, TestsNeurological tests.The doctor will also evaluate the patient's neurological status. This includes testing the ability to move, feee position of all limbs. In addition, the doctor will test the patient's reflexes to help determine injury to the spinal cord or individu

Imaging tests.After the physical examination, a radiologic evaluation is required. Depending on the extent of injuries, this macomputed tomography (CT ) scans, and magnetic resonance imaging (MRI) scans of multiple areas, including the thoracic an

Physical Examinat ionthe head, chest, abdomen, pelvis, limbs, and spine.

Emergency Stabi l izat ionAt first evaluation, it may be difficult to assess the extent of injuries to patients with fractures of the thoracic and lumbar spine.At the accident scene, EMS rescue workers will first check vital signs, including the patient's consciousness, ability to breathe,After these are stabilized, workers will assess obvious bleeding and limb-deforming injuries.Before moving the patient, the EMS team must immobilize the patient in a cervical (neck) collar and backboard. The trauma tea complete and thorough evaluation in the hospital emergency room.
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Top of pageComplicationsThere are several complications associated with fractures of the thoracic and lumbar spine. One potentiallyfatal complication is blood clots in the legs, which may develop from immobility. These clots can travel to t

he lungs and cause death (pulmonary embolism). Pneumonia and pressure sores are also common compli

cations of spinal fractures.There are also specific surgical complications, including: Bleeding Infection Spinal fluid leaks Instrument failure NonunionComplications can be reduced by early treatment, mechanical methods (lower leg compression stockings),

and medication to protect against clots, as well as proper surgical technique and postoperative programs.Top of pageLong-Term OutcomesRegardless of whether the patient is treated with surgery, rehabilitation will be necessary after the injury ha

s healed.The goals of rehabilitation are to reduce pain, regain mobility, and return the patient to as close to preinjury

state as possible. Both inpatient and outpatient physical therapy may be recommended to meet these goa

ls.Issues that may complicate these goals include inadequate reduction of the fracture, neurologic injury (paralysis), and progressive deformity.Top of pageShe was seen initially at an outside facility, with a reported Glasgow Coma Scalescore of 3 and no visual, verbal, or motor responses. She presented with a transverse abd

ominal ecchymosis (seat-belt sign) but was not injured intraabdominally. In addition, she pr

esented with bruising on her upper chest, particularly around the shoulders. On arrival at th

e trauma center, she underwent radiography and CT of the cervical and thoracic spine that

showed bilateral pulmonary contusions; a paraspinal hematoma; right first and second rib fr

actures; and complex fractures of the upper thoracic spinespecifically, fractures through t

he transverse processes of T1, T2, T4, and T5 on the left as well as bi-lateral transverse pr

ocess fractures of T3, fractures of the pedicle and lamina and posterior facets of T3, and co

mpression fractures of the T4 and T5 vertebral bodies (Figs.1A,1B,1C). Four hours after admission, her state of consciousness improved to a Glasgow Coma Scale score of 11, but

she was insensate below the level of the nipples and was unable to move her legs. MRI lat

er revealed a cord edema from C7 to T4 with spinal canal narrowing at T3 due to a retropul

Surgical ProcedureThe ultimate oal for sur er is to achieve ade uate reduction fittin the bones to ether , relieve ressure on the s inal cord

Rotation Fractu re PatternNonsurgical treatment.Transverse process fractures are predominantly treated with gradual increase in motion, with or witho

Extens ion Fracture PatternThe treatment plan for extension injuries will depend on:

Where the spine fails Whether the bones can be fit together again (reduction) using a brace or cast
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sed fragment (Figs.1Dand1E). Posttraumatic bone marrow edema was also present fromT3 to T7.

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and no visual, verbal, or motor responses. She presented with a transverse abdominal ecc

hymosis (seat-belt sign) but was not injured intraabdominally. In addition, she presented wit

h bruising on her upper chest, particularly around the shoulders. On arrival at the trauma ce

nter, she underwent radiography and CT of the cervical and thoracic spine that showed bila

teral pulmonary contusions; a pparaspinal hematoma; right first and second rib fractures; a

nd complex fractures of the upper thoracic spinespecifically, fractures through the transv

erse processes of T1, T2, T4, and T5 on the left as well as bi-lateral transverse process fra

ctures of T3, fractures of the pedicle and lamina and posterior facets of T3, and compressio

n fractures of the T4 and T5 vertebral bodies (Figs.1A,1B,1C). Four hours after admission, her state of consciousness improved to a Glasgow Coma Scale score of 11, but she was i

nsensate below the level of the nipples and was unable to move her legs. MRI later reveale

d a cord edema from C7 to T4 with spinal canal narrowing at T3 due to a retropulsed fragm

ent (Figs.1Dand1E). Posttraumatic bone marrow edema was also present from T3 to T7.


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Read More:http://www.ajronline.org/doi/full/10.2214/ajr.183.5.1831475Read More:http://www.ajronline.org/doi/full/10.2214/ajr.183.5.1831475Last reviewed: February 2010
http://www.ajronline.org/doi/full/10.2214/ajr.183.5.1831475http://www.ajronline.org/doi/full/10.2214/ajr.183.5.1831475http://www.ajronline.org/doi/full/10.2214/ajr.183.5.1831475http://www.ajronline.org/doi/full/10.2214/ajr.183.5.1831475http://www.ajronline.org/doi/full/10.2214/ajr.183.5.1831475http://www.ajronline.org/doi/full/10.2214/ajr.183.5.1831475http://www.ajronline.org/doi/full/10.2214/ajr.183.5.1831475

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Fracture Vertebrae