A thoracic burst fracture is a severe injury to a vertebra in the mid-back region. This fracture occurs when the vertebral body, the main part of the bone, shatters in multiple directions. Imagine a can crushed from the top, its sides bulging outwards; similarly, bone fragments can spread into the surrounding spinal canal.
This injury differs from a simple compression fracture, where only the front of the vertebra is crushed. A burst fracture involves the entire vertebral body, making it a more complex and potentially unstable condition. Dispersed bone fragments pose a higher risk of pressing on the delicate spinal cord or nerve roots, which can lead to significant complications.
Causes and Symptoms of a Thoracic Burst Fracture
Thoracic burst fractures result from high-energy trauma, often involving axial load and flexion. Common causes include severe motor vehicle accidents, falls from heights, and high-impact sports injuries. In individuals with weakened bones, such as from severe osteoporosis, a burst fracture can occur from less forceful events.
Symptoms cause severe, localized mid-back pain that worsens with movement. Neurological symptoms indicate injury severity, as bone fragments may compress the spinal cord or nerve roots. These include numbness, tingling, or weakness in the legs. Severe spinal cord compression can lead to loss of bladder or bowel control, or even paralysis below the injury level.
How a Thoracic Burst Fracture Is Diagnosed
Diagnosis begins in an emergency setting with a thorough physical and neurological examination. A doctor assesses pain, sensation, motor function, and reflexes. This initial assessment helps determine the extent of potential nerve or spinal cord involvement.
Imaging tests then visualize the spine and confirm the fracture. X-rays are often the first tool to identify bone injuries and assess alignment. A Computed Tomography (CT) scan is the definitive imaging method, providing detailed, three-dimensional images of the vertebra, bone fragment displacement, and proximity to the spinal canal. An MRI (Magnetic Resonance Imaging) scan is also used, especially for concerns about spinal cord injury or damage to soft tissues like ligaments and intervertebral discs. MRI provides a comprehensive view of any neural element compression.
Non-Surgical Treatment Approaches
Non-surgical treatment is considered when the fracture is “stable” and does not significantly compromise the spinal cord or nerve roots. A stable fracture means the spine is not at risk of further collapse or displacement that could worsen neurological function. The absence of neurological deficits, such as weakness or numbness, is a primary criterion for this conservative approach.
Non-surgical management primarily involves a custom-molded Thoracic-Lumbar-Sacral Orthosis (TLSO) brace. This rigid brace immobilizes the mid and lower back, limiting spinal movement and supporting the injured vertebra. The brace helps to maintain proper spinal alignment, allowing the fractured bone to heal naturally over several months, typically three to six months, by restricting forces that could cause further displacement. Pain management, including medication and rest, is also important for patient comfort during healing.
Surgical Repair Options
Surgical repair is the primary option when the injury leads to spinal instability or causes spinal cord or nerve root compression. An unstable fracture means the vertebral column’s structural integrity is compromised, risking further deformity or neurological deterioration. Evidence of significant nerve or spinal cord compression, often indicated by progressive weakness, numbness, or loss of bladder/bowel control, necessitates surgical intervention.
The main objectives of surgery are to decompress the spinal cord by removing bone fragments and to stabilize the injured spine segment. A common procedure is spinal fusion, permanently joining two or more vertebrae. During this procedure, orthopedic surgeons use specialized hardware, such as pedicle screws and rods, to hold the affected vertebrae in a stable position. A bone graft (from the patient or a donor) is placed around the hardware to promote new bone growth, encouraging the vertebrae to fuse over several months.
The Recovery Journey After Treatment
Recovery from a thoracic burst fracture varies significantly depending on surgical or non-surgical treatment. For non-surgical patients with a brace, recovery involves gradually weaning from the orthosis over several weeks or months, guided by imaging. Physical therapy then aims to regain strength, flexibility, and mobility in back and core muscles.
For surgical patients, initial recovery involves a hospital stay of several days to a week, with pain management and early mobilization. Upon discharge, restricted activity (avoiding heavy lifting, twisting, or bending) allows the surgical site to heal and fusion to begin. A structured physical therapy program is crucial for rehabilitation, focusing on progressive exercises to restore function, improve posture, and rebuild muscle strength. Regardless of treatment, recovery is a lengthy process, often taking six months to a year or more to achieve maximum improvement and return to daily activities.