Spinal Trauma / Fracture

The vertebral column usually consists of 33 vertebrae, 24 presacral vertebrae (seven cervical, 12 thoracic, and five lumbar), followed by the sacrum (five fused sacral vertebrae), and the coccyx (four frequently fused coccygeal vertebrae).

Most spinal fractures occur in the midback (thoracic spine) and the low-back (lumbar spine). Treatment often depends on the severity of the fracture and whether the patient has other injuries affecting the spinal cord and/or nerve function.

There are three different types of spine fractures. Dr. Ball will classify the fracture of the thoracic and/or lumbar spine based on the fracture’s specific pattern and whether there is a spinal cord injury. Classifying the fracture pattern helps to determine the proper treatment.

The three major types of spine fracture patterns are

• Flexion
• Extension
• Rotation

Flexion Fracture Pattern

A flexion fracture pattern can be either a compression fracture or an axial burst fracture. In a compression fracture, the front (anterior) of the vertebra breaks and loses height, but the back (posterior) vertebra does not. These fractures are usually stable fractures, meaning the bones have not moved out of place, and they are rarely associated with neurologic problems. Compression fractures commonly occur in patients with osteoporosis.

In an axial burst fracture, the vertebra loses height on both the front and back sides. It is often caused by landing on the feet after falling from a significant height. These fractures may sometimes result in nerve compression, and they can be either stable or unstable (the bones have moved out of place) fractures.

Extension Fracture Pattern

In an extension fracture pattern or flexion/distraction (Chance) fracture, the vertebra is pulled apart (distraction). This type of fracture can occur in a head-on car collision when the upper body is thrown forward while a lap seat belt stabilizes the pelvis. Typically, these are unstable fractures.

Rotation Fracture Pattern

A rotation fracture pattern can be either a transverse process fracture or a fracture-dislocation. In a transverse process fracture, which is uncommon, the fracture results from rotation or extreme sideways (lateral) bending. Usually, these fractures do not affect stability.

In a fracture-dislocation, there is a fracture and dislocation of the vertebrae. These fractures are unstable, and frequently they cause serious spinal cord compression and injury, often permanent.

High-impact trauma injuries suspect of thoracic or lumbar spinal fractures require emergency treatment at the accident site. EMS rescue workers will check the patient’s vital signs, including consciousness, ability to breathe, and heart rate. Once stabilized, the rescue workers will assess obvious bleeding and limb-deforming injuries.

Before moving the patient, the EMS team will immobilize the patient in a cervical (neck) collar and backboard.

Once at the hospital, the trauma team will complete and thoroughly evaluate the head, chest, abdomen, pelvis, limbs, and spine. The emergency doctor will assess the patient’s neurological status, including testing his or her ability to move, feel, and sense the position of all the limbs. Reflexes will also be tested to determine if there is an injury to the spinal cord or individual nerves. The tone of the anal muscles will be tested to determine if the patient is able to empty his or her bladder without assistance. Problems with bowel and bladder functions may indicate a more serious spinal cord injury.