Broken Back

Broken Back Overview

A broken back is a serious injury that occurs when the individual vertebrae of the back section of the spinal column become fractured or dislocated. The most common causes are vehicle accidents, falls, sports accidents or violent acts such as gunshot wounds.

Not all fractured spines are due to trauma, however. In people with osteoporosis, tumors or other conditions that cause bones to weaken, a fracture can occur during normal daily activities. Most fractures occur in the thoracic (mid back) and lumbar spine (lower back), or at the junction of the two.

If the individual vertebrae are fractured or severely dislocated but the spinal cord is undamaged, no neurological damage (paralysis) occurs. If the spinal cord becomes bruised or damaged due to swelling, trauma or laceration, neurological damage may result. That’s why it is extremely important to not move an injured person if you think they could be suffering a spinal injury. Call for emergency assistance.

There are several classifications of fractures. In a minor fracture a part of the back side of the vertebra has broken. The fracture is usually not severe. A major fracture means that part of the spine called the vertebral body (or lamina) has fractured. Because this area of the spine carries significant weight, a major fracture brings a higher possibility of nerve damage.

Vertebrae can break in several ways:

A compression fracture is common in people whose bones have been weakened by other conditions.
A burst fracture is caused by severe trauma and involves several areas of fracture.
Flexion-distraction fractures result when the spine is made to flex forward (as in some types of vehicle accidents), putting a great deal of stress on the spine.
A fracture–dislocation is a significant movement of the vertebrae and can occur with any type of fractures.

Wellstar neurologists and neurosurgeons are expert in assessing and treating spinal fractures. The goal is to minimize neurological involvement and maximize function and recovery.

We offer traditional and innovative procedures including vertebroplasty. In this procedure a medical-grade cement mixture is injected into a fractured vertebra. This stabilizes the vertebra and allows a patient to return to normal activity following a recovery period.

Symptoms

A broken back is a serious injury. You should see a doctor immediately if you believe or suspect you might have a spinal fracture.

The most typical symptom is moderate-to-severe back pain that gets worse with movement. In cases that involve the spinal cord symptoms can include numbness in the arms or legs, tingling, weakness or bowel/bladder problems. A significant trauma can cause a brain injury that leads to loss of consciousness (“blacking out”). Such incidents require immediate medical attention.

Other symptoms:

Sudden severe pain around the injured area
Swelling around the injury
Pain that travels down the arms or legs
Difficulty walking or moving
Paralysis (rare)

Risk Factors

One of the most significant risk factors for broken back is a previous spinal fracture within the past year. In some cases multiple fractures result in a serious misalignment of the spine, causing a tilting forward that looks like a hump. This is known as kyphosis.

Other risk factors:

Osteoporosis. Having brittle bones makes a fracture more likely.
Sex. Men are four times more likely than women to experience traumatic fractures of the thoracic or lumbar spine. But older women are more likely than older men to have compression fractures due to osteoporosis.
Age. Age-related fractures are usually due to weakened bone from osteoporosis.
Trauma.
Cancer.
Use of antipsychotic medications.
Poor mental functioning.
Poor mobility.
Poor strength.
Participation in high-impact sports.

Broken Back Prevention

The best way to prevent a broken back is to treat underlying causes like tumors and osteoporosis.

For more ways to prevent a broken back, see below:

Always wear seat belts to minimize injury in a vehicle accident.
Wear appropriate protective gear when playing sports.
Be cautious to avoid falls.

Broken Back Diagnosis

Make an appointment to see your Wellstar neurologist if you or a loved one has been in an accident, sustained a serious fall or injured the back in another way. Some spinal fractures that do not result from trauma can be difficult to diagnose because patients have minimal discomfort. Some older patients may consider back pain a normal symptom of aging.

Diagnosing a spinal fracture starts with a physical examination. The doctor will ask questions about your pain and about a traumatic event that may be the cause. The doctor will also want to know about your general medical history, lifestyle and activities. He or she will ask you to move in various ways to test your range of motion and learn what movements make the pain better or worse.

If the doctor suspects a spinal fracture, he or she will likely conduct a neurological exam to test your ability to move, and feel and sense the position of all limbs. The exam helps with:

Tests reflexes to assess a possible injury to the spinal cord or individual nerves.
Determines muscle strength.
Helps determine if the pain is traveling from the back to other areas of the body.

Tools and Tests

Wellstar neurologists may use one or more imaging tests to learn what type of spinal fracture you have and to assess its severity. Tests may include:

X-ray
CT scan to see what may be pressing on the nerve and spinal cord.
MRI scan to show soft tissues like discs and nerves.

In the case of a traumatic injury, these tests may be conducted after the patient has been stabilized to minimize any possible involvement of the spinal cord.

Broken Back Treatment

If the fracture is due to a traumatic incident, treatment will start with stabilization of the patient by emergency responders at the accident scene. They will address the patient’s consciousness, ability to breathe and heart rate. Because the extent of the injuries and involvement of the spinal cord is unknown, the emergency response team will take precautions by mobilizing the patient in a neck collar and backboard.

Once the patient has been stabilized and other life-threatening injuries addressed, the neurologist will evaluate the fracture and determine whether surgery is needed.

If you witness or come upon a traumatic accident that may involve a spinal fracture call paramedics immediately. Hold the person’s head and neck in the position in which they were found. Do not attempt to reposition the neck and do not allow the neck to bend or twist.

Surgery

Your neurologist and neurosurgeon will assess the fracture, symptoms, your overall health and other factors to determine if surgery is the right option.

Surgery for unstable burst fractures is common when there is:

Significant fracture fragments.
Severe loss of vertebral body height.
Excessive forward bending at the injury site.
Significant nerve damage due to vertebrae or disks pinching the spinal cord.

The goal of surgery is decompression of the spinal canal and stabilization of the fracture. Decompression involves removing the bone or other elements pressing on the spinal cord. The procedure is also known a laminectomy.

Surgery for an extension fracture injury may be necessary if there is an injury to the back (posterior) ligaments of the spine. Also, if the fracture falls through the disks of the spine, surgery will be used to stabilize the fracture.

Surgery for fracture-dislocations of the thoracic and lumbar spine (caused by significant trauma) is used to fit the bones together, relieve pressure on the spinal cord and nerves and facilitate movement.

Your Wellstar neurosurgeon will discuss the benefits and risks with you in detail. One potential complication of surgery is blood clots in the legs, which can travel to the lungs and cause death.

Other possible complications are:

Bleeding
Infection
Spinal fluid leaks
Instrument failure (problems with the metal implants inserted during spine surgery)
Nonunion (failed spinal fusion)
Complications can be minimized by prompt treatment, mechanical strategies like compression stockings and medication to guard against blood clots.

Non-surgical Treatment

Most compression or stable burst fractures can be treated by placing the patient in a back brace for six to 12 weeks. During the period the patient will gradually increase physical activity and rehabilitation exercises.

Extension fractures are often treated non-surgically by placing the patient in a brace or cast for 12 weeks and closely monitoring the situation.

Rotation fractures may be treated with or without bracing, and a gradual increase in motion.

Ongoing Care for Broken Back

Many people who suffer spinal fractures heal successfully and are able to comfortably perform the daily activities they are accustomed to. Whether your treatment includes surgery or not, you will need rehabilitation to reduce pain, regain mobility and return to pre-injury activities. Wellstar offers excellent inpatient and outpatient rehabilitation led by highly trained physical and occupational therapists.

Working together with patients and their families, Wellstar rehabilitation helps people achieve their greatest level of independence and achieve a smooth transition to home and community. Your doctor will discuss rehabilitation with you as part of an overall treatment plan for a broken back.