Spine FRACTURES
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Falls or trauma can cause spinal fractures. Although some of these injuries do not require surgery, large fractures should be treated promptly and appropriately. Delaying treatment in large spinal fractures can cause serious long-term problems.
Fractures or dislocations due to minor accidents and traumas are frequently seen in patients with osteoporosis . Osteoporosis or weakening of the bones can cause serious injuries even in simple accidents.
Spinal fractures can lead to extremely serious consequences as they affect the nerve structures passing through the spine and the vital vessels and organs around it. 70 percent of spinal fractures occur in the dorsal and lumbar vertebrae, 5-10 percent in the neck vertebrae, the rest in other parts of the spine.
In partial paralysis, especially when it is determined that the paralysis is progressively progressing, surgery is absolutely and urgently required. In most of these patients, complete or almost complete recovery can be achieved.
Spine and Spinal Cord Anatomy
Let's briefly review the anatomy of the spine to understand the spinal fracture issue a little better. The spine consists of 33 bones called vertebrae, which are connected to each other by soft tissue, joints and intervertebral pads (disc).
This chain of vertebrae forms a support structure that allows our body to stand upright and to move in all directions (bending forward, backward, turning to the sides). In addition, at the back of each vertebra there is a ring of bone structure through which the spinal cord passes, and these protect the spinal cord.
The spinal cord consists of nerve tissue that provides the connection between the brain and the arms, trunk and legs and carries orders from the brain to these regions. By acting just like an electrical cable; It enables our hands and arms, feet and legs, and our sensory function to work. It also helps us breathe, controls urine and stool functions.
What Are Spinal Injuries?
can range from mild soft tissue trauma to spinal fracture and spinal cord injury. Spinal fractures and dislocations can cause spinal cord injury and thus paralysis. The treatment of spinal injuries also varies according to the severity of the case.
Where Do Spinal Fractures Occur?
5-10% of fractures occur in the cervical vertebrae, 70% in the dorsal and lumbar vertebrae, and the remainder in the lower regions. The most frequently injured area is the 12th dorsal vertebra and the 1st lumbar vertebra, where the dorsal and lumbar vertebrae meet, in the most mobile region of the spine.
Reasons
When a force, such as a fall or impact, is applied to the spine, the bone in the spine may not be able to carry the load. This can cause the spine to be crushed and fractured. If the compression is light, you will only experience mild pain and minimal deformation.
usually occurs after high-energy traumas (traffic accident, falling from a height, jumping, etc.). There is also a special type of spinal fractures caused by the problem of osteoporosis, which causes the bones to lose their strength. These fractures, which can occur even in normal daily activities, develop due to bone weakness (osteoporosis), which is more common in older ages.
the trauma affecting the spinal cord or nerve roots is severe, severe pain may be experienced. This can cause kyphosis after a while. Especially in osteoporosis patients, this is among the most common risk factors for fractures, especially spinal fractures, as the disease causes weakening of the bones.
Spinal Fractures may develop due to the following reasons:
- Accidents due to falls, sports or other causes
- osteoporosis
- Spinal tumors
What Are the Causes of Spine Fractures?
Spinal fractures usually develop due to high-energy trauma . Traffic accidents are shown as one of the most common causes. Apart from this, falls (especially falls from height), gunshot injuries and sports accidents are among the main causes of spinal fractures. In the elderly with osteoporosis and in patients with spinal tumors, severe fractures may occur even after low-energy traumas such as minor falls, as the spinal bones affected by these diseases weaken.
Who is most affected by spinal fractures?
80% of patients with spinal fractures are between the ages of 18-50. Men are 4 times more likely to suffer a spinal fracture than women.
Symptoms
What Are the Symptoms of Spinal Fractures?
Early symptoms of spinal fractures vary according to the severity and location of the injury. Neck, back and low back pain and muscle spasm are the main findings. If there is a spinal cord injury, there may be various complaints such as numbness, numbness in the arms and legs, loss of strength, incontinence or inability to pass urine .
In the late period, if adequate treatment is not applied in patients without nerve injury, the most common complaint is the humpback ( kyphosis ) of the spine and the severe pain it may cause . Patients with nerve injuries, on the other hand, face paralysis and the problems it brings.
The primary and most important symptom is pain. Every patient who has suffered a trauma and presents with pain in any part of the spine , without exception, is considered as "spine fracture in very severe traumas, in cases where the patient is unconscious or without the patient's need to describe the pain, until proven otherwise".
Symptoms of a spinal fracture can vary depending on the severity of the injury. The following symptoms can be seen in spinal fractures;
- back or neck pain
- numbness, tingling, muscle spasm
- Weakness
- Changes in the intestines or bladder
- Paralysis
- If symptoms such as loss of movement in the arms or legs are observed, a doctor should be consulted as soon as possible.
Diagnostic Methods
In spinal injuries, it is extremely important to make the patient lie down without moving too much and to inform the ambulance as soon as possible. If the doctor suspects spinal fractures, he may request radiography, computed tomography , MR images to make the definitive diagnosis of the patient .
How is the Diagnosis of Spine Fractures?
In cases of spinal injury, it is very important to transport the person to the nearest hospital and the way the procedure is performed. Ambulance and expert paramedics should be waited for the transportation.
Failure to carry the patient in an appropriate position is one of the most important factors affecting the fate of the injury. After being brought to the emergency room, doctors may request the following tests to make the diagnosis by performing the first intervention and examination.
Direct Radiography
It is the first examination to be performed on patients with suspected injury, often it can successfully reveal whether there is an injury.
Computed Tomography
It shows fractures better than direct radiography. It is routinely practiced in some hospitals. In other cases, it may be requested to evaluate the severity and type of fractures seen on direct radiography .
Magnetic Resonance Imaging (MR)
It is one of the best methods for evaluating the spinal cord and soft tissues. It is not necessary for every patient, but may be requested in patients with fractures to assess the severity of the fracture and the condition of the soft tissues.
It may also be requested in cases of unexplained spinal cord injuries or in cases where the levels of spinal cord injury and spinal fracture do not match.
How Does a Spinal Cord Injury Occur?
Spinal cord injuries usually occur after spinal fractures, when the broken bone narrows the canal through which the spinal cord passes. However, it can also occur with excessive stretching of the spinal cord without any bone fracture, especially in children. Spinal fractures and injuries can occur in any part of the spine from the neck to the coccyx.
How Many Ways Can Spinal Fractures Occur?
fractures
If more load is placed on a bone than it can withstand, the bone will break. The most common type of fracture is "compression fractures", in which the anterior portion of the vertebrae collapses. If the load on the spine is even more severe, then the middle and posterior parts of the vertebrae may also be broken and the broken parts may displace towards the spinal canal and injure the spinal cord.
This type of fracture is called a "blast fracture". Although spinal cord injury and paralysis are common in blast fractures, not every blast fracture causes paralysis or spinal cord injury. Fractures are usually in a single vertebra, but may involve 20% or 30% of multiple vertebrae, either consecutive or non-consecutive.
Dislocations and Fractures-Dislocations
If the loads on the spine increase even more, then with the fracture in the bone, in the soft tissues that connect the vertebrae and hold them together; Injury to discs, ligaments and joints can occur. In this case, the two vertebrae are disconnected from each other and spinal dislocation may occur.
While spinal dislocation is rarely seen as a dislocation caused by injury to soft tissues, it is often seen as a "fractured dislocation" together with a vertebral fracture. With these two types of injury, spinal cord injury often develops and becomes one of the most dangerous forms of injury.
At the same time, dislocations and fracture-dislocations are much more difficult to heal than injuries with only fractures. For these reasons, dislocations or fractured dislocations often require surgical treatment.
Treatment Methods
Spinal Fractures Treatment
First of all, a specialist physician determines whether the spine can carry the load-bearing function and whether there is a nerve injury. The main approach is pain treatment in patients who do not cause neurological injury and are thought to have no problem in the load bearing of the spine ( stable ).
Depending on the situation, limited periods of bed rest and restraint corsets may be recommended. However, if the integrity of the spine is disrupted and unable to carry out its load-bearing function ( unstable ) due to fracture, and especially if there is partial or complete paralysis, surgical treatment is definitely applied (with some minor exceptions).
What are the Treatments for Spinal Fractures?
It aims to control pain and ensure the integrity of the spine and repair it in patients without spinal cord injury.
The main goals are to prevent the damage to the injured spine from progressing over time and causing a hump, or to prevent an injury to the spinal cord with increasing humpback.
In the patient with spinal cord injury, conditions such as bone pressure and spinal cord compression that cause the injury are tried to be corrected. The early application of this treatment is especially important in patients with partial paralysis.
Because patients with partial paralysis have a higher chance of recovery. In patients with complete paralysis, the chance of recovery may be less. However, for the early rehabilitation of these patients , the fractured spine should be repaired quickly and its integrity should be regained.
Which Treatments Can Be Applied in Spinal Fractures?
Corset or Plaster Treatment
A fixation is necessary for the healing of fractures. Corset or plaster treatment is preferred especially in compression fractures, in patients without spinal cord injury and soft connective tissue injury.
The aim is to heal the fracture with external fixation, to prevent the spine from collapsing further and putting pressure on the spinal cord and the development of humpback. The plaster or corset period usually covers a period of 3 months.
Instrumentation and Fusion
It is the fixation and freezing of the broken spine using metal tools. This process can be done from the front or back of the spine, sometimes both sides need to be frozen, while fusion can take months.
At the same time, bone fragments compressing the spinal cord in patients with spinal cord injury can be removed during surgery. It is the treatment method of choice in burst fractures in which posterior connective tissues are injured without neurological injury, and in all other burst fractures, fractures or fracture dislocations with neurological injury.
Vertebroplasty & Kyphoplasty
invasive treatment method that can be applied in some selected compression fractures, osteoporosis or tumor-related fractures, and some burst fractures . It can be applied under local anesthesia. It is based on the principle of placing titanium cage-cement in order to enter the spine with large needles through small incisions to be made on the skin, and to fix and strengthen the fracture.
Spinal Fractures Surgery
Two main surgical methods are used in spinal fractures: