Vertebral Fracture: Causes, Types, Symptoms, Risk Factors, Complications, Diagnosis
What is Vertebral Fracture?
Vertebral fractures are mostly caused as a result of forceful compression due to trauma resulting from an accident. The severities of the vertebral fractures vary widely. Some of the vertebral fractures need emergency room treatment while other vertebral fractures are a result of weakened bones caused by diseases such as osteoporosis.
A vertebral fracture is not the same as a fracture on the arm or leg. When there is a vertebral fracture, damage to the spinal cord or spinal nerves can occur as a result of bone fragments poking the spine. These kind of fractures arise from motor accidents, sports injuries, severe falls and even gunshots. The injuries vary and one can suffer a simple muscle strain, breakage of the bony vertebrae or damage to the spinal cord. Symptoms of vertebral fracture vary with the degree of injury from difficulty in walking to partial or full paralysis. Pain is common on sustaining a vertebral fracture and treatment is mainly conservative for mild injuries though severe injuries of vertebral fracture may need surgery to restore the functionality of the bones.
A serious trauma like a car crash or a serious fall from a raised place can cause fractures to the midback and lower back. Fractures to the lumbar and thoracic spine need treatment immediately as the damage could result in loss of neural abilities.
Most fractures occur when the bone snaps or breaks but the vertebra does not actually snap like a twig but crashes instead. This kind of crash is what is commonly referred to as compression fracture.
A compression vertebral fracture may bring sudden back pain that gets worse with movement. It may also result in pain that is not necessarily localized to the spine but on the abdomen. Sometimes, though, the compression fracture can be completely painless and not bring any other symptoms. In such a situation, especially for middle aged and elderly women, height loss is a big sign of a vertebral fracture. Any deformity of the back could also be an indicator of vertebral fracture.
Some patients end up with more than one vertebral fracture mostly in the thoracic part of the spine though sometimes it occurs in the lumbar part of the spine as well. If one has experienced a vertebral fracture before, the likelihood of getting more fractures is very high. This condition could result in not just the loss of height but also thoracic kyphosis which is the hunching of the upper back and development of dowager's hump. Kyphosis can have a negative effect on one's posture, health and even appearance. It comes about as a result of osteoporosis, wear and tear of the spinal joints and disks over time among other causes. It results in an exaggerated rounding of the curve that goes forward in the upper back resulting in a stooped forward posture. This stooping compresses the chest wall as well as the abdominal organs and could affect breathing and digestion as well.
Causes of Vertebral Fracture
Vertebral fracture arises from different causes with motor accidents being the biggest cause at 45 percent. Falls result in 20 percent of the vertebral fractures, sports injuries accounts for 15 percent of vertebral fractures, violence 15 percent and other causes account for only 5 percent of the vertebral fractures. The vertebral fracture can also arise from conditions such as osteoporosis and spine tumors.
Vertebral fractures affecting the upper and the lower backs could arise from different causes such as:
- Car accidents
- Falls from elevated places
- Severe sporting accidents
- Gunshot as well as
- Weakened bones from conditions like osteoporosis.
In most of these situations, the victim not only has a vertebral fracture but also other injuries requiring immediate attention. Sometimes though the fracture do not require high impact activities to occur and can simply arise from simple activities like stretching to reach for something or twisting the back. These kinds of fractures affect people with weakened bones as a result of bone insufficiency and do not develop in an instant but overtime with no symptoms until the bone breaks.
Types of Vertebral Fracture
Multiple types of vertebral fractures exist. The vertebral fractures are classified based on the fracture pattern as well as the severity of the injury resulting in spinal cord injury. This classification helps doctors determine the best treatment plan. There are three major categories of vertebral fractures based on pattern. They are:
- Flexion vertebral fracture
- Extension vertebral fracture
- Rotation vertebral fracture
Flexion Vertebral Fracture
- A compression fracture is caused by forces transmitted along the vertebral body. The ligaments remain intact and the fracture is usually stable making it hard to detect. These fractures mostly affect people with osteoporosis and may be triggered by trivial traumas. Pathologic vertebral fractures may occur with metastatic cancer as well as other processes affecting the vertebrae.
- A fall from a height can also produce what is referred to as an axial burst vertebral fracture though a considerable amount of force is required to compress a healthy vertebra.
Extension Vertebral Fracture
Flexion/distraction (Chance) fracture. This fracture is produced by a flexion-distraction mechanism. Fracture lines are seen extending into the posterior elements of the vertebrae on a lateral view. They sometimes produce minimal anterior compression and can easily be confused with compression fractures. They mostly arise from the seat belt restraint in an accident. They occur together with abdominal injuries but are less likely to cause neurologic deficits.
Rotation Vertebral Fracture
Transverse process vertebral fracture. Not all fractures of the spine are clinically important. The transverse processes of the vertebrae are bony projections that can be fractured without any clinical consequence and do not require treatment.
Fracture-dislocation vertebral fracture. This one arises when the vertebra shifts from an adjacent vertebra and creates an unstable injury that affects both bone and soft tissue. This kind of vertebral fracture can cause a serious spinal cord compression.
Signs and Symptoms of Vertebral Fracture
Signs and symptoms related to vertebral fracture vary depending on the nature and extent of the injury. They include numbness, pain in the neck or back, tingling of the muscles, general body weakness, changes in bowel and bladder patterns and even paralysis.
Signs of a vertebral fracture affecting the spinal cord can be pain or the development of neural deficits like:
- Muscle spams
- Lack of sensation
- Neurogenic shock- It is a complication of acute complete spinal cord injury above the thoracic T6 level and results in hypotension as a consequence of spinal cord ischemia.
- Spinal shock
An injury to the upper back or lower back could cause neural deficits in the pelvic area, stomach and even the legs.
A fracture affecting the upper back or the lower back results in very intense pain that increases even with the slightest movement.
If the spinal cord gets affected, the patient suffers a distortion of the bowel and bladder movements and may also experience fragility in the limbs, lack of sensation and tingling.
If the vertebral fracture occurred as a result of high impact trauma, the patient may suffer a brain injury and even loss of consciousness. There may be other injuries as well that cause even more pain thus masking the back pain and they are usually referred to as distracting injuries. It is normally advised that after a high-energy trauma event like a car accident, the first responders assume that the patient suffered a spinal injury to avoid making the injuries worse in case they exist.
Who is Most Affected with Vertebral Fracture?
- The most affected people are young adults aged between 18 and 25 years
- Men are also likely to fracture their vertebrae 4 times more than women.
Risk Factors for Vertebral Fractures
Certain things make you more susceptible to vertebral fracture. They are:
- Weakened bones due to osteoporosis is a major risk factor for vertebral fracture.
- Physical injuries
- Injury to vertebra especially if within a year ago is a risk factor for vertebral fracture.
- Inability to move around easily
- Not having good body strength
- Being on psychotic drugs
- Usage of proton pump inhibitors.
- Cancer is also a factor of risk for vertebral fracture.
Complications in Vertebral Fracture
The following complications can arise from vertebral fracture affecting the upper and lower backs:
- Blood clots may occur in the legs or pelvis due to lack of movement after the injury following the vertebral fracture surgery.
- Blockage of an artery in the lungs due to a blood clot a condition known as pulmonary embolism is a complication of vertebral fracture.
- Lung conditions such as pneumonia is a complication of vertebral fracture..
- Damage to the skin resulting in a breakout (pressure sores) due to being in a single position for long periods of time.
The surgery of the spine in vertebral fracture could also give rise to the following complications:
- Leakage of the spinal fluids is a complication of vertebral fracture surgery.
- Failure of the instruments.
The, doctors, however, take you through the potential risks and put measures in place to reduce the risk of complications which arise due to vertebral fracture. These measures include:
- Early diagnosis and treatment.
- Use of compression stockings on the legs as well as prescription of drugs to reduce the risk of blood clots.
- Use the correct surgery techniques.
- Follow-up after surgery.
Tests to Diagnose Vertebral Fracture
Emergency Treatment for Vertebral Fracture
Patients who have suffered vertebral fracture on the upper and lower backs after a serious injury require emergency treatment. The extent of these vertebral fractures are difficult to determine on first evaluation.
At the scene of the accident, the first responders check the patient's vital signs such as their ability to breathe, the heart rate and consciousness. Once the patient is stable, they then check for bleeding and other injuries like fractures.
The emergency rescue team must use a collar on the neck and a backboard before moving the patient to avoid further injuries. Once in hospital, the trauma team performs an in-depth examination of the patient.
Physical Examination for Vertebral Fracture
At the hospital, the doctor does a thorough examines the patient with vertebral fracture from head to toe inspecting the head, chest area, abdomen, hip region, the arms and legs as well as the spine itself.
Other Tests to Diagnose Vertebral Fracture
- Neurological tests are done to diagnose vertebral fracture. The doctor also conducts these tests to determine whether the patient can move or feel the legs and arms. Once it is determined that they can feel the limbs, the doctor then conducts tests to evaluate the patient's reflexes in order to determine whether the spinal cord and nerves are injured.
- Imaging tests are also conducted to diagnose vertebral fracture. Once the physical tests have been completed, the doctor may order for a radiologic evaluation. The radiologic tests vary depending on the extent of the injuries and could be X-rays, Magnetic Resonance Imaging (MRI), or Computed Tomography (CT) scans. The MRI covers the entire spine giving a clearer look of the thoracic and lumbar spine.