The spine serves as the central support structure for the body, allowing for movement while protecting the delicate spinal cord. This column is composed of 33 individual bones, called vertebrae. A spinal fracture involves a break in one or more of these vertebrae, which can occur from high-impact trauma, such as a car accident or fall, or from underlying conditions like osteoporosis. Because the spinal cord runs through the center of this bony structure, any fracture represents a serious injury that necessitates immediate and specialized medical attention.
Immediate Signs and Symptoms
Sudden, severe back or neck pain localized to the site of the injury is the most common indication of a spinal fracture. This pain is often intensified significantly by any attempt to move, stand, or walk, and may feel less intense when lying completely still. The body may react to the trauma by initiating involuntary muscle spasms in the surrounding area, which further compounds the discomfort and restricts mobility.
Beyond localized pain, a more concerning set of symptoms indicates potential involvement of the spinal cord or exiting nerve roots. Damage to these neurological structures can manifest as numbness, tingling, or a “pins and needles” sensation radiating into the arms, torso, or legs. Patients may also experience muscle weakness, making walking unstable or impossible.
In the most severe instances, a spinal fracture can lead to a complete loss of function below the level of the injury, resulting in paralysis. Another serious sign of nerve compression is the sudden loss of control over bladder or bowel function, which represents a true medical emergency. Recognizing these neurological changes is essential for determining the urgency and type of medical intervention.
How Doctors Classify the Injury
The diagnostic process begins with imaging studies to accurately assess the extent and pattern of the bony injury. Initial X-rays provide a quick view of the vertebral alignment and bone structure, while a Computed Tomography (CT) scan offers detailed, cross-sectional images of the bone fragments. A Magnetic Resonance Imaging (MRI) scan is used to evaluate soft tissues, such as the spinal cord, ligaments, and intervertebral discs, which is essential for determining if there is neurological compromise.
Doctors classify spinal fractures based on the injury’s morphology, or pattern, and its stability, which determines the risk of further damage to the spinal cord. Compression fractures, where the front portion of the vertebra collapses, are often seen in individuals with weakened bone from osteoporosis. These are generally considered stable if the posterior part of the bone remains intact.
A more severe injury is a burst fracture, which occurs when the vertebra is crushed in multiple directions, potentially sending bone fragments backward into the spinal canal. Fracture-dislocations are the most unstable type, involving both a bone break and the displacement of the vertebra from its neighboring segments, frequently causing significant ligament disruption. Classification systems, such as the Thoracolumbar Injury Classification and Severity Score (TLICS), assign numerical values based on the fracture type, ligament integrity, and the patient’s neurological status. This scoring system informs the treating physician whether non-surgical or surgical management is appropriate.
Treatment and Stabilization Methods
Stabilizing the fractured segment, managing pain effectively, and preventing further injury to the spinal cord or surrounding nerves are the goals of treatment. Treatment pathways are non-surgical and surgical options, based on the fracture’s stability and the presence of neurological deficits. Stable fractures, such as many simple compression fractures, are often managed without an operation.
Non-surgical management typically involves strict bed rest for a short period, combined with pain management medications to control discomfort. Patients are often fitted with a rigid external brace or orthosis, which works to immobilize the spine and restrict movement for a period of eight to twelve weeks, allowing the bone to heal in a proper alignment.
Surgical intervention becomes necessary for unstable fractures or those causing significant spinal cord or nerve compression. Procedures are designed to decompress the neural elements and provide internal stability. Spinal fusion is a common technique where rods, screws, and plates are used to join two or more vertebrae together, eliminating movement until the bones fuse into a single, solid unit.
For compression fractures, minimally invasive procedures like vertebroplasty and kyphoplasty may be employed to relieve pain and restore vertebral height. Vertebroplasty involves injecting bone cement directly into the fractured vertebra to stabilize it. Kyphoplasty is similar, but first uses a balloon to gently expand the collapsed vertebra before the cement is injected. These cement augmentation procedures offer rapid pain relief and structural support, often allowing for quicker mobilization than traditional open surgery.
The Recovery Process and Long-Term Outlook
Once the spine has been stabilized through bracing or surgery, the focus shifts to the long-term recovery process. The initial phase of rehabilitation concentrates on restoring flexibility and building strength in the core and back muscles, which are necessary to support the spine after the acute healing period. Physical therapists guide patients through controlled exercises to regain mobility that may have been lost due to immobilization or nerve injury.
Recovery can range from a few months for stable, non-operative fractures to a year or more for complex injuries with neurological damage. Patients who undergo surgery may begin PT within a few weeks, often seeing significant functional improvement within six to twelve weeks of consistent therapy. Rehabilitation also includes occupational therapy to help patients adapt to performing daily activities while protecting the healing spine.
Despite successful treatment, some individuals may face long-term challenges, including chronic pain at the injury site or a progressive spinal deformity, such as kyphosis, that can affect posture. If the spinal cord sustained permanent injury, patients may have persistent neurological deficits, such as muscle weakness or altered sensation, requiring ongoing adaptive strategies. Adherence to a prescribed, long-term exercise program and maintaining bone health are important factors in maximizing functional recovery and mitigating the risk of future fractures.