Information about traumatic fracture of vertebral column

General information about fracture of vertebral column

A fracture of spinal column can occur as a result of an automobile accident, a fall, and other types of injuries. Although some fractures don’t require surgical treatment, most fractures must be treated correctly and in time. If serious spinal fractures are left untreated, long-term and even irreversible damage can result.

The figure shows a compression fracture of the spinal column

Anatomy of the spinal column and spinal cord

To further understand the seriousness of spinal column fractures, let’s go over the anatomy of these entities. The spinal column consists of 33-34 vertebrae that are connected by ligaments, muscles, joints and intervertebral discs. The spine is made up of 7 cervical, 12 thoracic, 5 lumbar and 4-5 sacral vertebrae.

The picture shows the cervical, thoracic, lumbar, sacral vertebrae and spinal cord

The vertebral column helps support balance (helps you stand up straight), turn to either side (forward, backward, bend to the side and turn), by providing support for the body. In addition, each vertebra consists of a body and spurs that create a ring that protects the spinal cord.

The spinal cord is made up of tissue that supports the interaction between the brain and the arms, trunk and legs, as well as transporting signals coming from the brain. Similar to an electrical cable: this connection facilitates the work of our hands, arms, legs and sensory organs. At the same time, it controls the acts of breathing, urination and defecation.

The diagram shows the connection between the brain and the muscles

The diagram shows the connection between the brain and the internal organsThe extent of spinal cord injuries varies from mild soft tissue damage, vertebral fracture to spinal cord damage. Vertebral fractures and dislocations can cause damage to the spinal cord, which can result in paralysis. The course of treatment depends on the extent of the injury.

Statistically, 5-10% of injuries are to the cervical vertebrae, 70% to the thoracic and lumbar vertebrae, and the rest to the sacrum and coccyx. In the majority of cases, the most mobile zone of the spine, which is the junction area between the 12th thoracic vertebra and 1st lumbar vertebra (T12 to S1), is injured.

Causes

In falls, car accidents, and other injuries, vertebrae can’t withstand the weight that is placed on them. This can cause damage and fracture of the spine. Most spinal column fractures occur as a result of high-energy injuries. Automobile accidents are the most common cause, and bullet wounds and sports injuries are also included. 80% of patients are in the 18-50 age. Among men, spinal cord injuries are 4 times more common than among women.

How is the examination done?

Symptoms of spinal cord injuries vary depending on the severity of the injury. The following symptoms may occur with spinal cord injuries:

• Pain in the neck, chest, and lower back
• Numbness, muscle spasm
• Weakness in the extremities
• Involuntary urination and defecation
• Paralysis (decreased sensation and strength of movement) in the extremities

If these symptoms are detected, you should see a doctor immediately. The first symptoms of the spinal column injury vary depending on the localization and severity of the injury. Pain in the neck, chest, lower back and muscle spasm are the main symptoms. When the spinal cord is injured, there may be complaints of numbness (stiffness) in the arms and legs, loss of muscle strength, and involuntary acts of urination and defecation.

When the spinal cord is damaged, there may be complaints of numbness (stiffness) in the arms and legs, loss of muscle strength, and involuntary acts of urination and defecation. With nerve damage, patients experience paralysis, and the problems that follow. To transport a patient with a spinal cord injury, you must wait for the emergency physician and paramedic specialists. The patient must remain motionless. If a patient with an unstable spinal column fracture and an intact spinal cord is not properly transported, the vertebrae may dislocate and cause damage to the spinal cord, causing paralysis. Proper transport of the patient is one of the main factors affecting the fate of the injury. After the patient is taken to the emergency room, an initial examination is performed, and the following instrumental diagnostic techniques are used to confirm the initial diagnosis.

Diagnosе

X-ray is the first method of examination that is performed on patients with a suspected spinal cord injury. It allows you to find out the presence or absence of a fracture in a short period of time.

X-rays of a spinal column fracture at the level of the cervical and lumbar vertebrae

Computer tomography (CT) scans show the structure of the fracture better than X-ray. It is used as a routine diagnostic method in some clinics. Allows to clarify the type and severity of fractures detected by X-ray.

Presented CT scans of vertebral fractures in coronal (frontal), axial, and sagittal views

Magnetic resonance imaging (MRI) is the best method to evaluate the spinal cord and soft tissue. It is not necessary to be performed for every patient, but the examination is worthwhile if there is back pain and normal X-rays and CT scans. A “chance injury”, which is a tear of the ligaments behind the intervertebral discs with the vertebrae intact, may be seen. At the same time, MRI scans are performed to thicken the fracture angle and soft tissue condition.

MRI images of a spinal fracture at the level of the cervical and lumbar vertebrae

Damage to the spinal cord occurs after vertebral fragments penetrate the spinal canal. Along with this, in rare cases, especially among children, spinal cord injuries can occur without pathology detected on x-rays (SCIWORA- Spinal Cord Injury without Roentgologic Abnormalities). This pathology can only be detected by MRI. Compression fractures, in which the anterior portion of the vertebrae is injured, are the most common.

Dennis classification of vertebral column fractures

When there is very high pressure on the spinal column, a fracture occurs in the anterior and posterior parts of the vertebrae, and fragments can penetrate and damage the spinal cord. This type of fracture is called an “explosive” fracture. Although spinal cord damage and paralysis occur in many splinter fractures, not every “explosive” fracture does. The fracture most commonly occurs at the level of a single vertebra, but in 20-30% of cases it can be multiple, occurring in adjacent and other vertebrae. In severe trauma, there is damage to the connective tissue, intervertebral discs, ligaments, and joints. In this case, there is a divergence of vertebrae and spinal column dislocation.

Spinal column dislocations are rarely caused by soft tissue damage, but “fracture dislocations” are common in fractures. Damage to the spinal cord is seen in both types and is the most dangerous type of injury. Recovery for dislocations is longer and more severe than for fractures. Therefore, surgical treatment is required for these injuries.

“Explosive” fracture at the T3 level and “dislocated fracture ” at the T10 to T11 level

Treatment of vertebral column fractures

The main principles of treatment are to reduce pain, restore the structure of the spinal column, and prevent damage to the spinal cord.

Conservative treatment

For a type I Dennis fracture (fracture of the only anterior column or a compression fracture), corset treatment is used. The patient must wear a corset in sitting and standing positions. The corset should be rigid and chosen according to individual parameters. The corset should be worn for about three months. Treatment based on wearing a corset is recommended for patients with compression fractures and without spinal cord and soft tissue damage.

Surgical treatment

Patients with a spinal cord injury need to eliminate the pressure of the bone on the spinal cord, within the first 6 to 8 hours of injury. Early surgical treatment is very important for patients who have developed partial paralysis, as this treatment can lead to its elimination. Patients with complete paralysis have slightly less chance of absolute healing. However, early surgery and stabilization of the vertebral column fracture are important for the early rehabilitation of such patients.

The goals of treatment are to stabilize the fracture site with fixation and prevent further compression of the vertebrae and spinal cord. If the vertebral body is completely fractured, surgeon removes all fragments and replaces them with titanium structures that are filled with bone fragments to fill the void.

During vertebral column fractures, surgery is used with anterior access, posterior access, or a combination of both. Replacement of the vertebra with a titanium fracture construct using an anterior approach is indicated.

Vertebroplasty and Kyphoplasty

This is a minimally invasive technique that is used for certain fractures. The surgery is performed under local anesthesia. A 1 cm incision is made, then a needle is passed to the left and right side of the vertebra, passing through the vertebral processes, and then cement (Polymethylmethacrylate) is used to fill the front and back of the vertebra body, thereby strengthening the vertebra.