What Are Spinal Fractures?

Spine fractures are common traumas in orthopedics. The incidence of fractures accounts for 5% to 6% of fractures, with the highest incidence of thoracolumbar fractures, followed by the cervical and lumbar vertebrae, the thoracic vertebrae are the least, and spinal cord or cauda equina injuries can often occur. Spinal fractures are more common in young men. Most of them are caused by indirect external force, which is caused by the hip or foot landing when the fall is high, and the impact external force is uploaded to the thoracolumbar segment. The clinical manifestations are deformity and pain of the spine after trauma, often accompanied by spinal cord injury.

Basic Information

English name: spinal fractures
Visiting department: orthopedics
Multiple groups: Young male

Common locations: spine
Common causes: Caused directly or indirectly by external forces
Common symptoms: Localized swelling, tenderness, and movement disorders

Causes of spinal fractures

Spinal fractures are more common in young men. Most of them are caused by indirect external forces, which are caused by hips or feet landing when falling from a high place, and impactive external forces upload to the thoracolumbar segment; a few are caused by direct external forces, such as house collapse injuries, car crush injuries, or firearm injuries. In severe cases, paraplegia can be caused, and even life-threatening; improperly treated simple compression fractures can also leave chronic low back pain.

Clinical manifestations of spine fractures

1. The patient has a significant history of trauma, such as a car accident and a fall from a height. Trunk compression.

2. The spine may be deformed during examination, and subcutaneous congestion can be seen in the spinal process fracture of the spine. Local pain in the wound, such as neck pain, chest and back pain, low back pain, or lower extremity pain. The spinous process has obvious shallow tenderness, spinal and back muscle spasm, and tenderness and throbbing pain in the fracture. When the cervical spine is fractured, flexion and extension or neck rotation are restricted. Thoracic spine fractures have limited trunk movements, and breathing restrictions may occur with rib fractures. When there is a lumbar fracture, there is obvious tenderness in the waist, and the lower extremity feels low back pain.

3. Spinal cord injury is often associated with incomplete or complete paralysis. Such as loss of sensation, motor function, and urination.

Spinal fracture examination

Imaging studies can help define the diagnosis, the location, type, and displacement of the defect.

1. X-ray film

X-ray imaging is the preferred method of examination. The elderly feel sluggish, and thoracolumbar spine fractures often complain of lower back pain. Simple lumbar radiography will miss the lower thoracic spine. Therefore, it must be noted that the imaging site includes the lower thoracic spine. Usually, In order to take two films on the front and side, add an oblique film if necessary. On the oblique film, you can see whether there is a fracture of the vertebral arch.

2.CTX line check

Due to its limitations, it can not show the pressure in the spinal canal. Anyone who has a middle column injury or has neurological symptoms must be examined by CT. CT examination can show the fracture of the vertebral body, and can also show the presence of bone fragments protruding into the spinal canal, and can calculate the anteroposterior and transverse diameter loss of the spinal canal.

3.MRI

CT scans cannot show spinal cord injury. For this reason, MRI examinations should be performed if necessary. On the MRI scans, you can see the signal changes caused by vertebral fracture bleeding and hematomas in front, and abnormalities due to spinal cord injury. High signal.

Spinal fracture diagnosis

Comprehensive diagnosis based on trauma history, clinical symptoms and imaging examination.

Spinal Fracture Treatment

Upper cervical spine injury

(1) Double fracture of atlanto-anteroposterior arch (Jefferson fracture) The vertical violence of the head caused the occipital condyle to strike the atlanto-vertebra causing fractures at the junction of the lateral mass and the anterior and posterior arches. The patient had only neck pain. The treatment was mainly Halo frame fixation for 12 weeks and skull traction.

(2) Atlantoaxial dislocation There is no fracture of the atlantoaxial vertebra, but the dislocation between the vertebral tooth process and the anterior arch of the atlas due to the rupture of the ligament can compress the spinal cord. The main treatments are reduction under traction and atlanto-axial fusion.

(3) Teeth fractures can be divided into type I (dental avulsion fracture); type II (fracture at the base of the tooth process and the junction of the vertebral body); type III (extending tooth fracture and the vertebral body) . Non-surgical treatment is suitable for type I, type III, and type II without displacement, and it is fixed with Halo stand for 6 to 8 weeks (type III is extended to 12 weeks). Surgical treatment is mainly applicable to type II fractures with displacement greater than 4mm.

(4) The fracture of the vertebral arch (hanger fracture / traumatic spondylolisthesis) The violence of the injury comes from the sacrum , leading to excessive extension of the cervical spine, vertical fracture of the vertebral arch, backward displacement after vertebral arch fracture, The body is displaced forward and the spinal canal volume increases. Although it does not compress the spinal cord, it has neck pain. The patients without displacement were mainly fixed by traction or Halo for 12 weeks. The treatment of patients with displacement were: traction, internal fixation and bone graft fusion.

2. Lower cervical spine injury

(1) Non-surgical treatment of flexion and compression fractures is suitable for I degree, mainly for neck brace fixation for 8-12 weeks; surgical treatment is suitable for degree II and above, mainly for fracture vertebrectomy, internal fixation and bone graft fusion. .

(2) Burst fractures are treated by surgery; pay attention to spinal cord injury.

(3) Surgical treatment of dislocation of the articular process ; pay attention to the presence or absence of intervertebral disc herniation.

(4) External fixation of posterior cervical fractures for 8-12 weeks.

(5) Surgical treatment is needed when cervical hyperextension injury is significantly displaced.

3. Thoracic and lumbar injuries

(1) Non-surgical treatment of compression fractures is suitable for patients with anterior column compression less than 1 degree and spinal kyphosis angle less than 30 °. It is mainly bedridden and strengthens the function of lumbar and back muscles; surgical treatment is suitable for spinal compression near II / III 2. Patients with kyphosis at angles greater than 30 ° and neurological symptoms are mainly reduction, decompression, fixation and bone graft fusion.

(2) Non-surgical treatment of burst fractures is suitable for patients with small kyphosis, spinal canal involvement less than 30%, and no neurological symptoms, mainly in bed for about 2 months; surgical treatment is suitable for obvious kyphosis, spinal canal More than 30% of the patients with neurological symptoms are mainly reduction, decompression, fixation and bone graft fusion.

(3) Chance fracture was overextension for 3 to 4 months; surgery was performed with obvious spinal ligament / disc injury.

(4) Fracture-dislocation and spinal cord injury often require surgery.

(5) You can rest in bed with attachment fracture .

Spinal fracture prognosis

Depending on the degree of spinal cord injury, recovery is better if there are no obvious neurological symptoms. Once the spinal cord is completely damaged, recovery is often difficult.