What are the main causes of thoracic and lumbar spine fractures. How are spinal fractures classified. What are the symptoms of a spinal fracture. How are spinal fractures diagnosed and treated.

Understanding Thoracic and Lumbar Spine Fractures

Spinal fractures, particularly those affecting the thoracic (midback) and lumbar (lower back) regions, can vary significantly in severity and cause. These injuries can result from high-energy trauma or occur in individuals with weakened bones due to conditions like osteoporosis. Understanding the nature of these fractures is crucial for proper diagnosis and treatment.

Common Causes of Spinal Fractures

Spinal fractures can occur due to various reasons:

• High-energy trauma (e.g., car accidents, falls from height, sports injuries)
• Violent acts (such as gunshot wounds)
• Osteoporosis-related fractures
• Tumors weakening the bone structure
• Minor falls or twisting movements in individuals with weakened bones

Is there a difference between traumatic and non-traumatic spinal fractures? Indeed, traumatic fractures often result from sudden, high-impact events and may be accompanied by other serious injuries. Non-traumatic fractures, on the other hand, can develop gradually in people with underlying bone conditions, sometimes without noticeable symptoms until a bone breaks.

Classification of Spinal Fractures

Doctors classify thoracic and lumbar spine fractures based on the specific pattern of the fracture and the presence of spinal cord injury. This classification helps determine the appropriate treatment approach.

Major Types of Spine Fracture Patterns

There are three primary categories of spine fracture patterns:

1. Flexion
2. Extension
3. Rotation

What are the specific types of fractures within these categories? Let’s explore each in detail:

Flexion Fracture Pattern

This category includes:

• Compression fracture: The front of the vertebra breaks and loses height, while the back remains intact. These are usually stable and rarely cause neurological issues.
• Axial burst fracture: Both the front and back of the vertebra lose height. These can sometimes result in nerve compression and may be stable or unstable.

Extension Fracture Pattern

The main type in this category is:

• Flexion/distraction (Chance) fracture: The vertebra is pulled apart, often occurring in car collisions when the upper body is thrown forward while the pelvis is restrained by a seatbelt. This is typically an unstable fracture.

Rotation Fracture Pattern

This category includes:

• Transverse process fracture: An uncommon fracture resulting from rotation or extreme sideways bending. It usually doesn’t affect stability.
• Fracture-dislocation: An unstable injury involving bone and/or soft tissue where a vertebra moves off an adjacent vertebra. These often cause serious spinal cord compression.

Recognizing Symptoms of Spinal Fractures

Identifying the symptoms of a spinal fracture is crucial for prompt diagnosis and treatment. The severity and location of the fracture can influence the symptoms experienced.

Common Symptoms

What are the typical signs of a thoracic or lumbar spine fracture? The most common symptoms include:

• Moderate to severe back pain, exacerbated by movement
• Numbness, tingling, or weakness in the limbs (if spinal cord or nerves are involved)
• Bowel/bladder dysfunction (in cases of nerve involvement)

In cases of high-energy trauma, additional symptoms may include:

• Loss of consciousness or “blackout”
• Other distracting injuries that may overshadow back pain

Can spinal fractures occur without immediate noticeable symptoms? Yes, particularly in cases of osteoporosis-related fractures, which may develop gradually over time without causing significant discomfort until a bone breaks.

Diagnostic Procedures for Spinal Fractures

Accurate diagnosis of spinal fractures is essential for determining the appropriate treatment plan. Healthcare professionals employ various diagnostic tools and procedures to assess the extent and severity of the injury.

Initial Assessment

How do medical professionals begin the diagnostic process for suspected spinal fractures? The initial assessment typically involves:

• Evaluation of vital signs, including consciousness and breathing ability
• Physical examination to check for visible injuries, bruising, or deformities
• Neurological assessment to determine any loss of sensation or motor function

Imaging Studies

What imaging techniques are used to diagnose spinal fractures? The most common imaging studies include:

• X-rays: Provide an initial view of the spine’s alignment and any obvious fractures
• CT (Computed Tomography) scans: Offer detailed images of the bony structures, helping to identify subtle fractures
• MRI (Magnetic Resonance Imaging): Provides detailed images of soft tissues, including the spinal cord and nerves

These imaging studies help doctors determine the exact location, type, and severity of the fracture, as well as any associated soft tissue injuries.

Treatment Options for Spinal Fractures

The treatment of thoracic and lumbar spine fractures depends on various factors, including the type and severity of the fracture, the presence of neurological deficits, and the overall health of the patient.

Non-Surgical Treatment

What are the non-surgical options for treating spinal fractures? For stable fractures without significant deformity or neurological issues, non-surgical treatments may include:

• Bracing: To immobilize the spine and allow for proper healing
• Pain management: Through medications and other modalities
• Physical therapy: To maintain strength and flexibility during the healing process
• Gradual return to activities: As guided by the healthcare provider

Surgical Intervention

When is surgery necessary for spinal fractures? Surgical treatment may be recommended in cases of:

• Unstable fractures
• Significant spinal deformity
• Neurological deficits
• Failure of non-surgical treatment

Surgical procedures may involve:

• Spinal fusion: Joining two or more vertebrae to stabilize the spine
• Vertebroplasty or kyphoplasty: Minimally invasive procedures to treat compression fractures
• Decompression: Removing bone or disc material to relieve pressure on the spinal cord or nerves

Recovery and Rehabilitation After Spinal Fracture Treatment

Recovery from a spinal fracture can be a lengthy process, requiring patience and dedication. The duration and intensity of rehabilitation depend on the severity of the injury and the type of treatment received.

Physical Therapy and Exercise

How does physical therapy contribute to recovery from spinal fractures? Physical therapy plays a crucial role in:

• Restoring strength and flexibility to the affected area
• Improving posture and body mechanics
• Preventing complications such as muscle atrophy or joint stiffness
• Enhancing overall functional capacity

A tailored exercise program may include:

• Gentle stretching exercises
• Core strengthening activities
• Balance and coordination exercises
• Gradual return to weight-bearing activities

Pain Management Strategies

What approaches are used to manage pain during recovery? Pain management is an essential aspect of rehabilitation and may involve:

• Medications: Including over-the-counter or prescription pain relievers
• Heat or cold therapy: To reduce inflammation and discomfort
• Massage: To alleviate muscle tension and promote relaxation
• Transcutaneous Electrical Nerve Stimulation (TENS): For non-invasive pain relief

Preventing Spinal Fractures: Risk Factors and Lifestyle Modifications

While not all spinal fractures can be prevented, understanding risk factors and making appropriate lifestyle changes can significantly reduce the likelihood of these injuries.

Identifying Risk Factors

What are the primary risk factors for spinal fractures? Key risk factors include:

• Osteoporosis: Weakens bones, making them more susceptible to fractures
• Advanced age: Increases the risk of falls and bone fragility
• Gender: Women are at higher risk due to hormonal changes and typically smaller bone structure
• Smoking: Reduces bone density and impairs healing
• Sedentary lifestyle: Leads to weaker bones and muscles
• Certain medical conditions: Such as rheumatoid arthritis or long-term steroid use

Lifestyle Modifications for Prevention

How can individuals reduce their risk of spinal fractures? Preventive measures include:

• Regular exercise: Particularly weight-bearing and resistance exercises to strengthen bones and muscles
• Balanced diet: Rich in calcium and vitamin D to support bone health
• Smoking cessation: To improve overall health and bone density
• Fall prevention: Making home modifications and improving balance
• Regular health check-ups: To monitor bone density and address any underlying conditions

By implementing these lifestyle changes and working closely with healthcare providers, individuals can take proactive steps to maintain spinal health and reduce the risk of fractures.

Long-Term Outlook and Quality of Life After Spinal Fractures

The long-term prognosis for individuals who have experienced thoracic or lumbar spine fractures can vary widely, depending on the severity of the injury, the effectiveness of treatment, and the patient’s overall health and commitment to rehabilitation.

Factors Influencing Long-Term Outcomes

What determines the long-term outlook for patients with spinal fractures? Several factors play a role:

• Severity and location of the fracture
• Presence or absence of neurological damage
• Timeliness and appropriateness of treatment
• Patient’s age and overall health status
• Commitment to rehabilitation and follow-up care

Potential Long-Term Challenges

What challenges might individuals face in the years following a spinal fracture? Some potential long-term issues include:

• Chronic pain: Particularly in cases of incomplete healing or nerve damage
• Reduced mobility: Which may impact daily activities and independence
• Increased risk of future fractures: Especially in patients with osteoporosis
• Psychological effects: Such as anxiety or depression related to physical limitations
• Changes in lifestyle: Including potential career adjustments or modifications to living arrangements

How can patients optimize their quality of life after a spinal fracture? Strategies for maintaining a good quality of life include:

• Adhering to prescribed treatment and rehabilitation plans
• Maintaining a healthy lifestyle with regular exercise and proper nutrition
• Seeking support from healthcare professionals, family, and support groups
• Adapting home and work environments to accommodate any physical limitations
• Staying engaged in meaningful activities and hobbies
• Regular follow-up with healthcare providers to monitor progress and address any new concerns

While the journey to recovery from a spinal fracture can be challenging, many patients can achieve significant improvements in function and quality of life with proper care, dedication to rehabilitation, and ongoing support. The key lies in a comprehensive approach that addresses both the physical and emotional aspects of recovery, empowering patients to adapt to their new circumstances and pursue fulfilling lives despite the challenges they may face.

Fractures of the Thoracic and Lumbar Spine – OrthoInfo

This article focuses mainly on spinal fractures due to trauma. For more in-depth information about osteoporotic spinal fractures, please read Osteoporosis and Spinal Fractures.

Spinal fractures can vary widely in severity. Some fractures are very serious injuries that result from high-energy trauma and require emergency treatment. Other fractures can be the result of a lower-impact event, such as a minor fall, in an older person whose bones are weakened by osteoporosis.

Most spinal fractures occur in the thoracic (midback) and lumbar spine (lower back) or at the connection of the two (thoracolumbar junction). Treatment depends on the severity of the fracture and whether the patient has other associated injuries.

Understanding how your spine works will help you to understand spinal fractures. Learn more about your spine: Spine Basics

The regions of the spine, including the thoracic spine (midback) and lumbar spine (lower back).

Fractures of the thoracic and lumbar spine may result from high-energy trauma, such as a:

• Car or motorcycle collision
• Fall from a significant height
• Sports accident
• Violent act, such as a gunshot wound

Many times, these patients have additional serious injuries that require rapid treatment. The spinal cord and/or nerves may also be injured, depending on the severity of the fracture.

Spinal fractures may also be caused by bone insufficiency. For example, people with osteoporosis, tumors, or other underlying conditions that weaken the bone can fracture a vertebra even during lower-impact events — such as reaching or twisting or falling from a standing height. These fractures may develop unnoticed over a period of time, with no symptoms or discomfort until a bone breaks.

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There are different types of spinal fractures. Doctors classify fractures of the thoracic and lumbar spine based upon the specific pattern of the fracture and whether there is a spinal cord injury. Classifying the fracture pattern will help your doctor determine the proper treatment.

The three major types of spine fracture patterns are:

• Flexion
• Extension
• Rotation

Flexion Fracture Pattern

Compression fracture. While the front (anterior) of the vertebra breaks and loses height, the back (posterior) part of it does not. This type of fracture is usually stable (the bones have not moved out of place) and is rarely associated with neurologic problems. Compression fractures commonly occur in patients with osteoporosis.

A compression fracture of the lumbar (lower) spine.

Axial burst fracture.  In this type of 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. An axial burst fracture can sometimes result in nerve compression. Some fractures are stable, while others are significantly unstable (the bones have moved out of place).

Extension Fracture Pattern

Flexion/distraction (Chance) fracture. The vertebra is literally pulled apart (distraction). This type of fracture can occur in a head-on car collision when the upper body is thrown forward while the pelvis is stabilized by a lap seat belt. This is typically an unstable fracture.

Rotation Fracture Pattern

Transverse process fracture. This uncommon fracture results from rotation or extreme sideways (lateral) bending. It does not usually affect stability.

Fracture-dislocation. This is an unstable injury involving bone and/or soft tissue in which a vertebra moves off an adjacent vertebra (displacement). These injuries frequently cause serious spinal cord compression.

Side view of a fracture-dislocation of a thoracic vertebra.

This MRI scan shows a fracture-dislocation in the thoracic spine. Note the disruption of the spinal cord.

A fracture of the thoracic or lumbar spine causes moderate to severe back pain that is worsened with movement.

If the spinal cord or nerves are involved, the patient may experience bowel/bladder dysfunction along with numbness, tingling, or weakness in the limbs.

If the fracture is caused by high-energy trauma, the patient may also have a brain injury and lose consciousness, or “black out.” There may also be other injuries—called distracting injuries—that cause pain that overwhelms the back pain. In these cases, it has to be assumed that the patient has a fracture of the spine, especially after a high-energy event such as a motor vehicle crash.

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Emergency Stabilization

Patients with fractures of the thoracic and lumbar spine that have been caused by trauma need emergency treatment. It may be difficult to assess the extent of their injuries on first evaluation.

At the accident scene, EMS rescue workers will first check the patient’s vital signs, including consciousness, ability to breathe, and heart rate. After the vital signs are stabilized, rescue workers will assess obvious bleeding and limb-deforming injuries.

Before moving the patient, the EMS team must immobilize the individual in a cervical (neck) collar and backboard. The trauma team will perform a complete and thorough evaluation in the hospital emergency room.

Physical Examination

The emergency room doctor will conduct a thorough evaluation, beginning with a head-to-toe physical examination of the patient. This will include an inspection of the head, chest, abdomen, pelvis, limbs, and spine.

The doctor will evaluate the patient’s neurological status. This includes testing his or her ability to move, feel, and sense the position of all the limbs. The patient’s reflexes will also be tested to help determine whether there has been an injury to the spinal cord or individual nerves.

The doctor may also check the tone of the anal muscles and determine whether the patient is able to empty his or her bladder without assistance. Problems with bowel and bladder function may indicate a more serious spinal cord injury.

Tests

Imaging tests. After the physical examination, a radiologic evaluation is required. Depending on the extent of injuries, this may include x-rays, computerized tomography (CT) scans, and magnetic resonance imaging (MRI) scans of multiple areas, including the thoracic and lumbar spine.

A CT scan taken from the side of a fracture-dislocation in the
thoracic spine.

A CT scan taken from the side of a burst fracture in the lumbar spine.

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Treatment for a fracture of the thoracic or lumbar spine will depend on:

• Other injuries and their treatment
• The particular fracture pattern
• Whether there is neurological injury

Once the trauma team has stabilized all other life-threatening injuries, the doctor will evaluate the spinal fracture pattern and decide whether spine surgery is needed.

Flexion Fracture Pattern

Nonsurgical treatment. Most flexion injuries–including stable burst fractures and osteoporotic compression fractures—can be treated with bracing for 6 to 12 weeks. By gradually increasing physical activity and doing rehabilitation exercises, most patients avoid post-injury problems.

Surgical treatment. Surgery is typically required for unstable burst fractures that have:

• Significant comminution (multiple bone fragments)
• Severe loss of vertebral body height
• Excessive forward bending or angulation at the injury site
• Significant nerve injury due to parts of the vertebral body or disk pinching the spinal cord
• Ligament damage that makes the spine unstable

These fractures should be treated surgically with decompression of the spinal canal (if there is nerve damage) and stabilization of the fracture. The procedure to decompress the spine is called a laminectomy. In a laminectomy, the doctor removes the bony arch that forms the backside of the spinal canal (lamina), along with any bone or other structures that are pressing on the spinal cord. Laminectomy relieves pressure on the spinal cord by providing extra space for it to drift backward.

To perform the laminectomy, your doctor will access your spine with an incision either on your side or on your back. Both approaches allow for safe removal of the structures compressing the spinal cord, while preventing further injury.

After the laminectomy, your doctor will stabilize the fracture by reconstructing the damaged bone or placing screws above and below the fracture.

Extension Fracture Pattern

Treatment for extension injuries will depend on:

• Where the spine fails
• Whether the bones can be fit together again (reduction) using a brace or cast

Nonsurgical treatment. Extension fractures that occur only through the vertebral body can typically be treated without surgery. These fractures should be observed closely while the patient wears a brace or cast for 12 weeks.

Surgical treatment. Surgery is usually necessary if there is an injury to the posterior (back) ligaments of the spine. In addition, if the fracture falls through the disks of the spine, surgery should be performed to stabilize the fracture.

Rotation Fracture Pattern

Nonsurgical treatment. Transverse process fractures are predominantly treated with a gradual increase in motion, with or without bracing, based on comfort level.

Surgical treatment. Fracture-dislocations of the thoracic and lumbar spine are caused by very high-energy trauma. They can be extremely unstable injuries that often result in serious spinal cord or nerve damage. These injuries require stabilization through surgery. The ideal timing of surgery can often be complicated. Surgery is sometimes delayed because of other serious, life-threatening injuries.

Surgical Procedure

The ultimate goals of surgery are to:

• Achieve adequate reduction (return the bones into their proper position)
• Stabilize the fracture
• Relieve pressure on the spinal cord and nerves
• Allow for early movement

Depending on the fracture pattern, the doctor may perform the procedure through either an anterior (front), lateral (side), or posterior (back) approach—or a combination of all three.

There are many types of specialized instruments used in spine surgery. These include metal screws, rods, and cages used to stabilize the spine.

An x-ray taken from the front shows metal screws and rods used to stabilize the spine after a burst fracture.

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Complications associated with fractures of the thoracic and lumbar spine include:

• Blood clots in the pelvis and legs—these may develop during long periods of bed rest or immobility
• Pulmonary embolism—a blood clot that breaks free and travels to the lungs
• Pneumonia
• Pressure sores

There are also specific complications associated with spinal surgery. These include:

• Bleeding
• Infection
• Spinal fluid leaks
• Instrument failure
• Nonunion
• Wound complications

Your doctor will talk with you about these risks and take specific measures to avoid potential complications. These measures may include:

• Early treatment
• Mechanical methods (such as lower leg compression stockings) and medications to protect against blood clots
• Proper surgical technique
• Postoperative programs

Regardless of whether treatment is surgical or nonsurgical, there will be a period of rehabilitation after a fracture has healed.

The goals of rehabilitation include:

• Reducing pain
• Restoring mobility
• Returning the patient as closely as possible to his or her preinjury state

Your doctor may recommend both inpatient and outpatient physical therapy to help you achieve these goals.

If your fracture was caused by osteoporosis, you are at an increased risk for additional fractures. Your doctor will recommend treatments to address bone density loss during your treatment and recovery.

In some cases, there may be issues that delay or complicate rehabilitation and recovery. These issues include inadequate reduction of the fracture, neurologic injury (paralysis), and progressive deformity of the spine.

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Fractured Vertebrae – Lower Back – Conditions – Musculoskeletal – What We Treat

What is a fractured vertebra in the lower back?

A fractured vertebra occurs when one of the bones (vertebra) in the lumbar spine is broken. Physiotherapy is an important treatment of fractured vertebrae in the lower back.

What can cause a fractured vertebra in the lower back?

The spine is made up of thirty-three bones or vertebrae which sit on top of each other like building blocks to support the back. The lumbar spine (lower back) consists of five vertebrae and these are the strongest least mobile of all of the vertebrae. Fractured vertebrae in the lower back are most commonly caused by road traffic accidents or a fall from a great height. It is also possible to obtain a fractured vertebra if you have spondylosis, which is osteoarthritis of the spine.

Above: Mobilisations of the vertebrea in the lower back by experienced therapist

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What are the symptoms of a fractured vertebra in the lower back?

Symptoms of a fractured vertebra include intense pain around the area of the fracture. They may be swelling and spasm due to the muscle around the vertebrae trying to protect the area. If the fracture was caused by a traumatic injury, there is likely to be broken skin, bleeding and other structures involved including blood vessels and surrounding nerves. Nearby nerves can get pinched by the rough bony edges of the fractured vertebra which may cause pins and needles and numbness in the buttocks, legs and feet. Other symptoms include:

• weakness
• abnormal reflexes
• stiffness
• gait problems

Above: Trigger point massage of the lower back muscles by specialist MSK therapist

What should I do if I have a fractured vertebra in the lower back?

If you think you may have fractured one of your vertebrae, you should visit your nearest accident and emergency department as soon as possible. Here, you will be able to get an accurate diagnosis of your injury and will have an X-ray to confirm this. You may also have to have other tests such as MRI scans, if your accident was more serious. You may find that applying ice wrapped in a wet towel to the area helps to reduce the pain and swelling slightly.

What shouldn’t I do if I have a fractured vertebra in the lower back?

Do not ignore your symptoms or try and treat the injury yourself. It is important that you receive a professional opinion as they will decide the best treatment plan for you. Avoid any activities that will increase the blood flow to the area such as massage, hot packs and hot baths or showers. Drinking alcohol also has this effect.

Above: Hacking percussion soft tissue massage conducted by an experienced therapist

Physiotherapy for a fractured vertebra in the lower back.

As soon as you receive a professional diagnosis of your injury, you will be able to begin a physiotherapy programme. Even if you are advised not to carry out strenuous activities, it is important to keep other joints mobile and strong to help optimise your recovery and prevent long term complications. Physiotherapy will include a variety of strengthening and range of movement exercises on different joints that will be tailored to your ability. Core strengthening is also very important as these are the deep muscles that help to support your lower back. Other physiotherapy treatment includes:

• Balance Exercises
• Soft Tissue Treatment
• Acupuncture
• Hydrotherapy

Can a fractured vertebra in the lower back have any long-term effects?

If you do not receive immediate treatment, your recovery may be delayed with the risk of other complications include stiff joints and weakness. Physiotherapy can also help with these more chronic problems.

Above: Rolling Soft Tissue Massage applied to the lower back by experienced therapist

To arrange a physiotherapy appointment call Physio.co.uk on 0330 088 7800 or book online.

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Sitemap – Federal Center for Neurosurgery, Novosibirsk

Prof.

Dr. Erkan Kaptanoğlu

Car accidents and falls account for the majority of spinal injuries. These accidents can cause fracture or crushing of one or more vertebrae. It can be the neck, back or lower back. Typically, the sudden onset of pain in the neck, lower back, or back after an injury. Occasionally, fractures can be seen in patients with osteoporosis, although there is no history of obvious trauma.

Causes

1. Car accidents
2. Fall from height
3. Sports injuries
4. Gunshot wounds
5. As a result of an osteoporotic bone fracture.

Complaints

For spinal fractures due to trauma, such as a fall from a height, a traffic accident, the patient and doctor usually meet in the emergency room. Patients may experience pain in the neck, lower back, or back, depending on the location of the lesion. If a spinal fracture has damaged the spinal cord or the nerves that branch out from the spinal cord, the patient may experience paralysis in a number of ways. The patient may not move his arms or legs. To this weakness, you can add the loss of feelings. Control of urine and bowel movements may be impaired. Patients may only complain of pain in chronic fractures, such as osteoporotic fractures.

Diagnosis

The patient’s complaints, medical history and examination are very important for making a diagnosis. In addition, for the diagnosis it is necessary to do some tests.

1. X-ray shows spinal bone fractures and spinal bone alignment. Collapse and slippage can be seen in the bones of the spine.
2. Computed tomography (CT) provides detailed information about the structures of the bones of the spine. It clearly shows fragments of a broken bone that have fallen into the spinal canal. It shows the number, shape and type of fracture.
3. Magnetic Resonance Imaging (MRI) provides detailed information on soft tissues such as the spinal cord, nerve tissue, cartilage, ligaments and connective tissue among spinal structures. Thus, one can see damage to the spinal cord, if any, as well as the condition of the spinal cord, traumatic hernias accompanying a fracture of the spine, spinal cord or surrounding hemorrhages, ruptures of connective tissue and ligaments.

Treatment decision

After the patient’s complaint, history and examination, an X-ray examination of the spine is performed. With the help of these images, information is obtained about the state of the structures of bones and ligaments and damage to the spinal cord, and fractures are classified. Thus, after the diagnosis is made, it is decided what treatment the patient needs.

Non-Surgical Treatment

If a patient has a spinal fracture that does not require surgery, bed rest may be used for varying periods of time depending on the shape and location of the fracture. The use of corsets is often added to bed rest. The goal here is to reduce the mobility of the injured spine, speed up recovery, and reduce pain. You can use painkillers. Exercises can be done under the supervision of a physiotherapist. In cases where medical treatment is not enough, resort to surgical treatment.

Surgical treatment

The fracture can be in any part of the spine, from the top of the neck to the coccyx. This fracture may be accompanied by slippage, or it may simply be a collapse. It can be crushed by broken bones in the spinal canal. The vertebral body may be severely damaged after an injury, or the backs of the vertebrae may be fractured. The state of the spine and spinal cord is assessed in detail, the form and time of surgical treatment are decided. When making this decision, the general condition of the patient, past illnesses and other organs injured during the accident are also taken into account.

The aim of the operation is to return the spine to its previous function. The main goal is to relieve compression of the spinal cord and nerve roots. To do this, parts of the bone that press on the spinal cord are removed.