A vertebral fracture, commonly called a broken back, is a serious injury involving a break in one or more vertebrae of the spinal column. This injury is a medical emergency because the spinal column protects the central nervous system. Damage to the bony structures can directly compromise the delicate spinal cord or nerve roots. Recognizing the signs of a vertebral fracture is crucial, as the potential for severe, life-altering complications, including paralysis, requires immediate action.
Identifying Acute Pain and Physical Signs
The most common indicator of a vertebral fracture is the sudden onset of severe, sharp pain localized in the back or neck at the injury site. This intense discomfort often begins immediately following a traumatic event, such as a fall or accident. The pain is characteristically aggravated by any movement, including standing, walking, or bending, because these actions place mechanical stress on the fractured bone.
The pain frequently lessens when the person is lying still, as this position relieves some vertical load on the spine. Physical examination often reveals marked tenderness to the touch directly over the injured segment. This localized sensitivity strongly indicates bony damage beneath the skin.
Visible changes to the back’s structure may be present, especially with severe or unstable fractures. Bruising and swelling can occur around the site of impact, though these signs are not always present with non-traumatic compression fractures. A palpable irregularity or gap along the spine may indicate significant vertebral displacement.
Over time, especially with multiple compression fractures caused by conditions like osteoporosis, a change in posture may become noticeable. The front part of the vertebral body may collapse, leading to a wedging effect. This can cause a gradual loss of height or the development of a stooped, forward-curving posture known as kyphosis.
Recognizing Neurological Compromise
The most serious concern is that a fractured bone fragment or displaced vertebra will impinge upon the spinal cord. Any sign of neurological compromise suggests damage to these vital nerve pathways and elevates the urgency of the situation. The location of the symptoms relates directly to the level of the spinal injury; for example, a thoracic injury may affect leg function, while a cervical injury may affect both arms and legs.
One of the first signs of nerve root irritation is altered sensation in the extremities, called paresthesia. This manifests as tingling, burning, or a “pins and needles” feeling below the level of the fracture. A more pronounced deficit is the partial or complete loss of sensation, where the ability to feel touch, temperature, or pain is diminished or absent.
Motor function is also frequently impaired, ranging from muscle weakness (paresis) to complete inability to move the limbs (paralysis). Depending on the level of spinal cord involvement, a person may struggle to lift a foot or grip an object. This loss of movement below the fracture site indicates that motor signals from the brain are being blocked.
A severe sign of neurological injury, often associated with lower spine fractures, is the loss of bowel or bladder control. Incontinence or urinary retention signals damage to the nerve roots at the end of the spinal cord (cauda equina). This symptom requires immediate decompression to prevent permanent loss of function.
Common Causes and Risk Factors
Vertebral fractures generally arise from two distinct mechanisms: high-energy trauma or low-energy impact combined with pre-existing bone weakness. High-impact trauma is common in younger, healthy individuals when the spine is subjected to extreme forces. This typically occurs during motor vehicle collisions or significant falls from a height.
Other high-energy transfers include sports-related injuries or severe axial loading, such as landing hard on the feet. These violent forces often result in unstable fractures, like burst fractures, where the vertebra shatters into multiple fragments. This type of fracture significantly increases the risk of spinal cord damage.
In contrast, low-energy fractures, most commonly compression fractures, are associated with underlying conditions that compromise bone density. Osteoporosis is the most frequent cause, especially in postmenopausal women over 50, making bones brittle and weak. In these cases, a fracture can occur from minor stress, such as bending over or coughing.
Another significant risk factor is metastatic cancer, where tumors spread to the spine and weaken the vertebral bodies. These pathological fractures can occur spontaneously and may be the first sign of undiagnosed cancer. Other risk factors contributing to weakened bone structure include advanced age, previous spinal fractures, smoking, and excessive alcohol consumption.
Emergency Protocols and Immediate Action
If a vertebral fracture is suspected based on the injury mechanism or the presence of severe pain and neurological symptoms, immediately call for emergency medical services. Spinal injuries carry the potential for catastrophic consequences, requiring professional medical assistance quickly. The priority for anyone assisting the injured person is to prevent any movement of the spine.
Movement of the fractured vertebra can cause fragments to shift and lead to permanent damage to the spinal cord or nerve roots. Therefore, the injured person should not be moved unless they are in immediate, life-threatening danger. If movement is unavoidable, multiple people must carefully log-roll the person while maintaining the head, neck, and torso in a straight, aligned position.
While waiting for help, instruct the person to lie as still as possible. Their head and neck must be manually stabilized to prevent any twisting or bending motion. This support is achieved by kneeling at the person’s head and gently holding both sides of their head and neck. Do not attempt to lift, reposition, or apply any brace or collar unless specifically trained.
Avoid giving the person anything to eat or drink, including pain medication. They may require emergency surgery upon arrival, and a full stomach can complicate anesthesia. Continuously monitor their level of consciousness and breathing. Be prepared to relay all observed signs and the exact nature of the accident to emergency responders.