SPINAL FRACTURES

The human spine consists of 33 vertebrae. 26 of them located in the neck, back and lumbar region are separated from each other by flexible intervertebral discs and are connected to each other by complex ligaments, providing mobility. The function of the spine is to keep the body upright and to enable movement in all directions. Each vertebral bone has rings that form the canal through which the spinal cord passes. The spinal cord consists of nerves that provide communication between the brain and the body.

If a bone is subjected to more stress than it can withstand, a fracture occurs. The majority of spinal fractures (70%) occur in the back and lumbar vertebrae.

WHAT ARE THE CAUSES OF SPINE FRACTURES?

The most common causes of spinal fractures are trauma and osteoporosis. Spinal fractures are usually seen in young people due to traffic accidents, falls and other injuries. Older ages, mostly due to reasons that cause the bone tissue to lose its strength, such as osteoporosis (bone loss).

Occurrence of an osteoporotic fracture in an aging spine leads to the appearance of the humpback shape. In this way, the alignment of the spine worsens and balanced load transfer is disrupted. Exacerbation of the malalignment of the spine causes new fractures to occur, leads the patient to a process we call the fracture cascade, and may lead to an increased risk of nonunion.

Other causes of spinal fractures include primary bone tumors, multiple myeloma, metastatic tumors and degenerative spine diseases.

WHAT ARE THE TYPES OF SPINAL FRACTURES?

Spinal injuries can range in severity from mild soft tissue trauma to spinal fractures and spinal cord injuries. Spinal fractures and dislocations can cause spinal cord injury and therefore paralysis.

5-10% of fractures occur in the cervical vertebrae, 70% in the dorsal and lumbar vertebrae and the rest in the lower regions. The most frequently injured area is in the most mobile region of the spine, where the dorsal and lumbar vertebrae meet (12th dorsal and 1st lumbar vertebrae).

Spinal fractures can occur in three ways.

Compression fractures: 

This is the most common type. These are fractures in which only the front part of the vertebra collapses. Due to the fracture and collapse of the anterior wall of the vertebral body, the body of the vertebra takes the shape of a wedge. Since the back wall of the spinal body is not broken, the spinal canal in which the spinal cord is located is not affected by the fracture. Compression fractures develop especially due to osteoporosis and are more common in older women.

Burst fractures: 

If the load on the spine is more severe, then the middle and back part of the vertebra may break and the broken pieces may be displaced towards the spinal canal and damage the spinal cord. Spinal cord injury and paralysis are common in burst fractures.

Fracture-Dislocations: 

These are the types that cause the most serious consequences, and include fractures in bones as well as dislocations and slips in joints and ligaments due to damage. The spinal cord and nerves are likely to be affected.

WHAT ARE THE SYMPTOMS OF SPINAL FRACTURES?

The most characteristic symptoms of spinal fractures are neck, back and low back pain. Symptoms may differ depending on the severity of the fracture. While pain is observed in low-severity fractures, if the spinal cord is damaged during the fracture, complaints such as numbness in the arms, legs and urinary incontinence may also be observed. In severe cases, if the fracture is not treated, serious consequences such as spinal deformations such as kyphosis (hunchback) and paralysis can be observed.

DIAGNOSIS IN SPINE FRACTURES

From the moment a spinal injury is suspected, the patient must be transported to the nearest hospital appropriately. Failure to transport the patient in an appropriate position is one of the important factors affecting the consequences of the injury. If there is a suspicion of injury after the patient is brought to the emergency room, the first examination to be requested is direct radiography (x-ray). Most of the time, it can successfully distinguish whether an injury is present or not.

Computed Tomography shows fractures in more detail than x-ray. Nowadays, its use in trauma patients has increased. It helps in assessing the severity and type of fracture.

Magnetic Resonance Imaging (MRI) is the method in which the spinal cord and surrounding soft tissues are best evaluated. Although not necessary in every patient, it may be requested to evaluate the severity of the fracture and soft tissues.

TREATMENT OF SPINE FRACTURES

The aim of the treatment is to relieve the patient's pain, improve the quality of life, and restore the movement and stability of the spine. If the nerves and spinal cord are affected by the fracture, the aim is to remove the pressure on them and restore these structures to their normal functions.

The majority of spine fractures can be treated with non-surgical methods. Custom-fit back braces are generally used depending on the type of fracture. Surgical treatment should be considered in fractures that cause severe deformity in the spine, when the collapse due to the existing fracture is predicted to progress, when there is spinal cord damage, in fractures that are considered unstable, that are thought to cause spinal cord paralysis, and in fractures that are not considered to be union after 3-6 months.

Custom-fit back brace treatment: 

It is especially preferred in patients with depression fractures and in patients without spinal cord injury or soft tissue injury. The aim is to ensure the healing of the fracture by external fixation and to prevent the spine from collapsing further, causing spinal cord compression and the development of a hunchback. The duration of treatment is usually 3 months.

There are three types of surgical treatment methods.

Vertebroplasty (Bone cement application), Kyphoplasty (Bone cement application with balloon): 

It is a minimally invasive treatment method that can be applied to some selected depression fractures, osteoporosis or tumor-related fractures and some burst fractures. It can be applied under local anesthesia. It is based on the principle of entering the spine with large needles through small incisions on the skin, correcting the fracture and placing a titanium cage and/or cement inside to strengthen it.

Fusion and stabilization: 

It is the process of providing alignment of the broken spine using metal instruments and stabilizing it by providing bone union in the joints between the vertebrae. This procedure can be performed from the anterior or posterior side of the spine and sometimes arthrodesis may be required by providing bone union on both sides. At the same time, in patients with spinal cord injury, bone fragments compressing the spinal cord can be removed during surgery. It is the preferred treatment method for burst fractures in which the posterior ligament tissues are injured without neurological injury and all other burst fractures or fractures and fracture-dislocations with neurological injury.