Summary

A spinal fracture is a break in one or more vertebrae (the bones that make up the spine), which can occur from trauma (high-energy accidents, falls) or from weakened bones (osteoporosis, tumors). Think of your spine as a stack of bones protecting your spinal cord—when a vertebra breaks, it can damage the spinal cord (the bundle of nerves running through the spine), causing paralysis, numbness, or other neurological problems. Spinal fractures are serious injuries that require careful management to prevent spinal cord damage. The most common types are compression fractures (vertebra collapses, usually from osteoporosis) and burst fractures (vertebra explodes, usually from high-energy trauma). The key to management is recognizing the fracture (back pain, neurological symptoms), assessing for spinal cord injury (numbness, weakness, paralysis), immobilizing the spine (cervical collar, backboard), imaging to assess stability (X-ray, CT, MRI), and appropriate treatment (conservative for stable fractures, surgery for unstable or with neurological injury). Most stable fractures heal well with conservative treatment, but unstable fractures or those with spinal cord injury need urgent surgical intervention.

Key Facts

• Definition: Break in one or more vertebrae
• Incidence: Common (thousands of cases/year)
• Mortality: Low (<1%) unless complications (spinal cord injury)
• Peak age: Bimodal (young adults from trauma, older adults from osteoporosis)
• Critical feature: Back pain, may have neurological symptoms
• Key investigation: X-ray, CT (essential), MRI if neurological symptoms
• First-line treatment: Immobilization, assess stability, surgery if unstable or neurological injury

Clinical Pearls

"Immobilize first, ask questions later" — If you suspect a spinal fracture, immobilize the spine immediately (cervical collar, backboard). Don't move the patient until the spine is cleared.

"Assess for spinal cord injury immediately" — Check for numbness, weakness, paralysis, and bowel/bladder function immediately. Spinal cord injury is a medical emergency.

"CT is essential" — X-ray may miss fractures. CT is essential to assess the fracture pattern and stability. Don't rely on X-ray alone.

"Stability determines treatment" — Stable fractures can be managed conservatively. Unstable fractures or those with neurological injury need surgery.

Why This Matters Clinically

Spinal fractures are serious injuries that can cause permanent paralysis if not managed properly. Early recognition, proper immobilization, assessment for spinal cord injury, and appropriate treatment (surgery if unstable or neurological injury) are essential. This is a condition that emergency clinicians, orthopedic surgeons, and neurosurgeons manage, and prompt treatment can prevent permanent disability.

Structured Approach: ABCDE

A - Airway

• Assessment: Usually patent (may be compromised if cervical injury)
• Action: Secure if compromised, maintain cervical immobilization

B - Breathing

• Look: May have difficulty breathing (if high cervical injury)
• Listen: Usually normal
• Measure: SpO2 (usually normal)
• Action: Support if needed

C - Circulation

• Look: Usually normal (may have shock if other injuries)
• Feel: Pulse (usually normal), BP (usually normal)
• Listen: Heart sounds (usually normal)
• Measure: BP (usually normal), HR
• Action: Monitor if other injuries

D - Disability

• Assessment: Neurological examination (critical)
• Action: Assess for spinal cord injury

E - Exposure

• Look: Spinal examination (with immobilization)
• Feel: Tenderness (with care)
• Action: Complete examination, maintain immobilization

Specific Examination Findings

Neurological Examination (Critical):

Spinal Examination (With Immobilization):

• Tenderness: At fracture site
• Deformity: May have
• Movement: Don't test (maintain immobilization)

Special Tests

Natural History (Without Treatment)

Untreated Spinal Fracture:

• Stable: May heal but in wrong position
• Unstable: High risk of further injury, cord damage
• Poor outcomes: If not treated properly

Outcomes with Treatment

Factors Affecting Outcomes:

Good Prognosis:

• Stable fracture: Better outcomes
• No neurological injury: Better outcomes
• Early treatment: Better outcomes
• Young age: Better healing

Poor Prognosis:

• Unstable fracture: Worse outcomes
• Spinal cord injury: Permanent disability possible
• Delayed treatment: Worse outcomes
• Older age: May heal slower

Prognostic Factors

Key Guidelines

1. NASS Guidelines (2013) — Diagnosis and treatment of vertebral compression fractures. North American Spine Society

Key Recommendations:

• Immobilization
• Assess stability
• Surgery if unstable or neurological injury
• Evidence Level: 1A

Landmark Trials

Multiple studies on surgical vs conservative treatment, outcomes.

Evidence Strength

What is a Spinal Fracture?

A spinal fracture is a break in one or more of the bones (vertebrae) that make up your spine. Think of your spine as a stack of bones protecting your spinal cord (the bundle of nerves running through your spine)—when a vertebra breaks, it can damage the spinal cord, causing numbness, weakness, or paralysis.

In simple terms: One of the bones in your spine is broken. This is serious because it can damage the nerves in your spine, but with proper treatment, most people recover well.

Why does it matter?

Spinal fractures are serious injuries that can cause permanent paralysis if not managed properly. Early recognition, proper immobilization, assessment for spinal cord injury, and appropriate treatment (surgery if unstable or neurological injury) are essential. The good news? Most stable fractures heal well with conservative treatment, and most people recover.

Think of it like this: It's like breaking a bone in your spine—it needs careful treatment to prevent damage to the nerves, but most people recover well.

How is it treated?

1. Immobilization (Immediate):

• Cervical collar: If your neck is injured, you'll wear a collar
• Backboard: You'll be kept still on a board
• Why: To prevent further injury while we assess the fracture
• Don't move: Until your doctor says it's safe

2. Assessment:

• Neurological examination: Your doctor will check for numbness, weakness, or paralysis
• Tests: You'll have X-rays and CT scans to see the fracture
• Why: To see how serious it is and if your nerves are affected

3. Treatment:

• If stable (no nerve damage): You'll wear a brace, take pain medicine, and gradually start moving again
• If unstable or nerve damage: You'll need surgery to stabilize the spine and relieve pressure on the nerves
• Why: To help the bone heal and prevent nerve damage

4. Rehabilitation:

• Physical therapy: You'll do exercises to regain strength and movement
• Occupational therapy: If needed, to help with daily activities
• Why: To help you recover and regain function

The goal: Help the bone heal, prevent nerve damage, and help you regain function.

What to expect

Recovery:

• Stable fractures: Usually heal within 6-12 weeks with a brace
• Unstable fractures: Usually need surgery, recovery takes longer
• If nerve damage: Recovery varies—some people recover partially, some don't

After Treatment:

• Brace: You'll wear a brace for several weeks (if stable)
• Pain: Should improve over time
• Activity: You'll gradually return to activities
• Follow-up: Regular follow-up to monitor healing

Recovery Time:

• Stable fractures: Usually 6-12 weeks
• Unstable fractures: Usually months
• If nerve damage: Recovery varies, may be permanent

When to seek help

Call 999 (or your emergency number) immediately if:

• You have back pain after a serious accident or fall
• You have numbness, weakness, or paralysis
• You can't control your bladder or bowels
• You feel very unwell

See your doctor if:

• You have back pain after an injury
• You have back pain and numbness or weakness
• You have concerns about your back

Remember: If you have back pain after a serious accident or fall, especially if you have numbness, weakness, or can't control your bladder or bowels, call 999 immediately. Spinal fractures are serious, but with proper treatment, most people recover well. Don't move until your doctor says it's safe.