Vertebral Fracture

What is a vertebral fracture?

The human spine consists of single vertebrae. It is composed of cervical , thoracic, lumbar, sacral and coccygeal vertebrae. Each vertebra is made up of a vertebral body, vertebral arch, transverse processes and spinous process. These vertebrae create the spinal canal through which the spinal cord passes and the intervertebral discs are found between the individual vertebrae. Additional stabilization of the spine is provided by ligaments. The spinal nerves pass laterally between the vertebrae from the spinal cord.

Vertebral fractures account for only two percent of all bone fractures. Most commonly the vertebral body is affected, but also the other regions of the vertebra may be broken. If the spinal canal is also involved with injury to the spinal cord, a paraplegic syndrome may result.

The most widely used classification for vertebral fractures is the AO classification according to Magerl:

Type A - Compression injuries:  Vertebral fractures result from pressure - the vertebrae are "compressed." Such vertebral fractures are stable.  

Type B - Distraction injuries: Strong vertebral bending can overstretch and tear ligaments at the rear of the vertebrae. Simultaneously, a compression injury occurs at the front of the vertebrae. Because of the torn ligaments, the fracture can become unstable. Distraction injuries can also result from over-extending the spine, in in which case the ligaments on the front of the vertebrae are torn.

Type C - Rotational Injuries: Typically these injuries present together with distraction injuries. In addition to flexion or hyperextension, there are sideward forces exerted on the vertebrae which can displace the vertebrae. The injuries are highly unstable.

These different types are further divided into 3 groups and 2 subgroups. Both the gravity of the injury and the instability as well as the occurrence of neurological symptoms increase from A to C.

What are causes and symptoms of a vertebral fracture?

The most common cause of a vertebral fracture is the impact of major forces on the spine, such as falls from a great height and traffic or sports accidents. Direct forces rarely account for vertebral fractures. Certain pre-existing medical conditions predispose a patient to a vertebral fracture. Osteoporosis is a disease wich causes the bone mass of vertebrae to become brittle. Also systemic skeletal diseases such as ankylosing spondylitis weaken the bone. In this case even slight forces or a light fall can lead to a vertebral fracture. Similarly a spinal tumors can cause a vertebra to break.

Vertebral fractures often result in intense pain. Yet it is possible for vertebral fractures to hurt only slightly or even be asymptomatic. It is rare to notice a palpable gap or hump along the spinous processes. Patients may present with limited range of motion or a relieving posture.

Neurological symptoms will be present in cases affecting the spinal cord or spinal nerves as well. Such symptoms include abnormal reflexes, sensory disturbances, paralysis or even paraplegia below the level of the injury.

How can a vertebral fracture be diagnosed?

In the event of an accident, a physician will want to know the exact circumstances of the accident as well as the direction of force. In addition, being aware of any pre-existing conditions is important, such as previous fractures or osteoporosis.

This is followed by a physical examination. They will examine whether walking and standing is possible and evaluate the patient's mobility. They also pay attention to painful areas, muscle tension and hardening in the back and check whether there are any sensory disturbances or signs of paralysis.  

Imaging is necessary to determine if a vertebral fracture is present. The first step is usually to take an x-ray in two planes. For a more detailed evaluation of the vertebral fracture, a computed tomography (CT) scan is also frequently conducted. This also provides a precise view of the spinal canal. Especially if an injury to the intervertebral disc or ligaments is suspected, magnetic resonance imaging (MRI) is helpful.

Should there be a possibility of injury to the spinal cord, a thorough neurological examination is always indicated as well.

How is a vertebral fracture treated?

The type of vertebral fracture determines the choice of treatment. If the fracture is stable, it is unlikely to result in neurological deterioration or a change in position. An unstable fracture is at risk of neurological deterioration caused by movement. In such cases, the spine must be stabilized. Other factors that determine the choice of therapy are the patient's age, bone quality, level of activity and the personal ambition.

Stable fractures oftentimes heal on their own. In older patients, physicians also more frequently choose not to perform surgery. After a brief period of bed rest, patients should begin moving as soon as the pain allows it. Physiotherapeutic assistance and sufficient pain management are crucial in this case. Periodic follow-up X-rays and CT and/or MRI scans will also be conducted by the physician.

In rare cases, an corset may be prescribed for stabilization. Options include a 3-point corset for a lower degree of spinal curvature or a plaster corset. Patients are asked to wear it for about three months.

In cases of young patients with stable fractures but spinal curvature of more than 20°, narrowing of the spinal canal or unstable fractures, doctors mostly opt for surgery.

What is the surgical approach to a vertebral fracture?

Different surgical techniques are available depending on the fracture. The goal is to stabilize the spine and minimize pressure on the nerves as quickly as possible. A possible solution is to repair the fracture with screws or plates (osteosynthesis).

When this is no longer possible, such as in the case of a comminuted fracture, surgeons may also opt for a laminectomy. This involves removing the vertebral arch as well as spinous process to decompress the spinal cord.

In a fusion surgery (spondylodesis) two or more vertebrae are braced. This can be accomplished utilizing a plate or bone graft.

For vertebral fractures that are the result of brittle bone mass, kyphoplasty is an option. Kyphoplasty is a minimally invasive surgery in which the surgeon straightens the vertebral body using a balloon and proceeds to stabilize it with a type of plastic (PMMA) or calcium phosphate.

Vertebroplasty is yet another possibility. This procedure is also minimally invasive. It involves stabilizing the vertebral body with cement, although without the use of a balloon.

How much time is required for a vertebral fracture to heal?

This depends on the nature of the fracture and also the patient's age. A stable fracture is ossified again after several weeks to months. However, patients can stand up immediately after surgery if they can tolerate the pain. Early movement is the goal for all vertebral fractures. Unstable fractures may take a longer time to heal and this depends on a variety of factors.

Which doctors and clinics are specialists for vertebral fractures?

Any patient wishes to have the best medical care for themselves. For this reason, patients may ask themselves where they can find the clinic that suits them best? Given that there is no objective answer to this question and a legitimate doctor would never claim to be the best, patients have to rely on a doctor's experience and education.

Let us help you find an expert for your condition. All of the doctors and clinics listed have been evaluated by us for their outstanding specialization in the area of vertebral fractures and are looking forward to your inquiry or request for treatment.