A burst fracture is a severe spinal injury where a vertebra breaks in multiple directions. This disrupts the vertebral body, the main cylindrical bone supporting the spine. Bone fragments can spread into the spinal canal, potentially compressing nerves and causing spinal cord injury. Immediate medical attention is crucial to prevent further damage.
Understanding the Injury
A burst fracture occurs when a vertebra experiences a high-energy axial load, a strong compression force along the spine. This force causes the vertebral body to shatter outwards. Bone fragments can displace into the spinal canal, compressing the spinal cord and nerves.
These fractures most commonly affect the thoracic and lumbar regions, especially the thoracolumbar junction (T10-L2). This area is vulnerable due to its transition from the rigid thoracic to the flexible lumbar spine, concentrating stress. Unlike a compression fracture, which involves only the front of the vertebral body collapsing into a wedge shape, a burst fracture shatters the entire vertebral body in multiple directions, making it inherently more unstable.
Causes and Symptoms
Burst fractures usually result from significant, high-impact trauma. Common causes include motor vehicle accidents, falls from heights, and sports injuries. Less severe trauma can cause a burst fracture if the spine is weakened by conditions like osteoporosis or a tumor.
Symptoms are immediate and intense. Severe back pain at the injury site often worsens with movement. Neurological symptoms may include numbness, tingling, or weakness in the limbs below the injury site. In severe cases, paralysis or loss of bowel or bladder control can occur, necessitating urgent medical evaluation.
Diagnosis and Treatment
Diagnosis begins with a physical examination and neurological assessment. Doctors also inquire about how the injury occurred. Imaging studies confirm the diagnosis and assess damage. X-rays provide initial bone views, while computed tomography (CT) scans offer detailed images of the fracture pattern and bone fragment displacement into the spinal canal. Magnetic resonance imaging (MRI) evaluates soft tissues like the spinal cord, nerves, and ligaments, detecting associated injuries.
Treatment varies based on fracture stability, neurological deficits, and spinal canal compromise. Non-surgical management, including bracing, pain medication, and rest, may be considered for stable fractures without significant neurological involvement or spinal cord compression. Surgical intervention is recommended for unstable fractures, those with neurological deficits, or when bone fragments compress the spinal cord or nerves. Surgical goals include stabilizing the spine, relieving pressure through decompression (removing bone fragments), and restoring spinal alignment. Spinal fusion, a procedure to permanently join vertebrae, often provides long-term stability.
Recovery and Outlook
Recovery from a burst fracture can be prolonged, often requiring physical therapy and rehabilitation. The duration and intensity of rehabilitation depend on the injury’s severity, neurological damage, and overall health. Physical therapy focuses on strengthening muscles, improving mobility, and restoring function.
The long-term outlook varies. Factors like initial fracture severity, neurological damage, and treatment effectiveness influence recovery. While some individuals achieve full recovery, others might experience residual pain, persistent neurological issues like numbness or weakness, or spinal deformity. Ongoing medical follow-up monitors spinal stability and addresses long-term concerns.