Spinal Fractures (Vertebral Fractures)

Vertebral fractures due to trauma, osteoporosis, or tumor

1Overview

Quick and clear information for patients

What is this Condition?

Spinal fractures (vertebral fractures) are breaks or collapse of the vertebral body resulting from trauma, osteoporosis, tumor, or infection. They most commonly occur in the lumbar (lower back) and thoracic (chest) regions. In elderly patients, bone loss (osteoporosis) can lead to compression fractures even from minimal trauma. In younger patients, high-energy trauma such as falls from height or motor vehicle accidents cause burst fractures or unstable fractures. Fracture types are classified as compression fractures (anterior wall collapse), burst fractures (complete vertebral fragmentation), and chance fractures (flexion-distraction injury). Stable fractures require conservative treatment, while unstable or neurologically damaging fractures require surgical stabilization. In osteoporotic fractures, vertebroplasty or kyphoplasty are minimally invasive treatment options. Early diagnosis and appropriate treatment preserve mobility and prevent chronic pain.

Symptoms

Severe lower back or back pain (sudden onset, worsened by immobility)

Height loss and kyphosis (kyphotic deformity, especially in osteoporotic fractures)

Tenderness to palpation (sensitivity at fracture site)

Limited mobility (difficulty with rotation and flexion)

Numbness and weakness in the legs (if nerve compression present)

Difficulty walking (in unstable fractures)

Difficulty breathing (in thoracic fractures)

Loss of bladder and bowel control (in spinal cord injury, rare)

Diagnosis Methods

Vertebral fractures are diagnosed through clinical evaluation and imaging. Plain radiographs (AP and lateral views) demonstrate vertebral height loss, angulation, and deformity on initial assessment. Computed tomography (CT) shows the fracture line, bone fragments, and canal involvement in detail; it is essential for surgical planning. Magnetic resonance imaging (MRI) evaluates spinal cord compression, nerve root compression, disc injury, ligamentous damage, and bone edema (sign of acute fracture); it distinguishes fracture age (acute versus chronic). STIR and fat-suppressed sequences demonstrate acute edema. Bone scintigraphy assists in detecting multiple osteoporotic fractures and metastatic lesions. Neurological examination evaluates motor strength, sensation, and reflexes; ASIA scoring grades spinal cord injury severity. DEXA (bone density measurement) determines osteoporosis presence and estimates fracture risk (T-score <-2.5). Instability criteria are evaluated using Denis three-column theory: anterior column (anterior longitudinal ligament + anterior 2/3 of vertebral body), middle column (posterior 1/3 of vertebral body + posterior longitudinal ligament), posterior column (pedicle, lamina, facet joints, interspinous ligament). Involvement of two or three columns indicates instability and requires surgery.

Treatment Methods

Treatment of vertebral fractures is determined by fracture type, stability, neurological injury, and patient's general condition. Stable compression fractures (especially osteoporotic) are managed conservatively: rest, analgesic medications, orthosis (thoracolumbar orthosis-TLSO) worn for 6-12 weeks, and early mobilization encouraged. In osteoporotic fractures, vertebroplasty (injection of bone cement into the fractured vertebra) or kyphoplasty (restoration of vertebral height with balloon followed by cement injection) are minimal invasive options for pain control; the procedure is performed under local anesthesia in 30-60 minutes, with 70-90% of patients experiencing rapid pain relief. Unstable fractures (burst fracture, Chance fracture), fractures with bone fragments in the canal, or those causing progressive neurological deficit require surgical stabilization. Surgical options include: posterior instrumentation (fusion with pedicle screws), anterior decompression and corpectomy (vertebral body removal and reconstruction with cage), 360° fusion (combined anterior and posterior approach). Early decompression in acute spinal cord injury (within 24 hours) increases chances of neurological recovery. Tumoral fractures additionally require oncological treatment (radiotherapy, chemotherapy) and surgical excision. Rehabilitation is essential for all patients: physical therapy, bone-strengthening exercises, osteoporosis treatment (bisphosphonates, denosumab, teriparatide), calcium and vitamin D supplementation. Complication risk is high: pseudarthrosis, implant failure, adjacent segment degeneration, chronic pain. With early diagnosis and appropriate treatment, prognosis is good, and most patients achieve functional recovery.

Vertebroplasty (bone cement injection)

Kyphoplasty (height restoration with balloon + cement)

Posterior Instrumentation (fusion with pedicle screws)

Anterior Decompression and Corpectomy (vertebral body removal + cage)

Conservative Treatment (orthosis, rest, analgesics)

360° Fusion (combined anterior and posterior surgery)

Osteoporosis Treatment (bisphosphonates, denosumab, calcium/vitamin D)

Physical Therapy and Rehabilitation

References

Greenberg MS. Handbook of Neurosurgery. 10th ed. Thieme; 2023.
Winn HR, ed. Youmans and Winn Neurological Surgery. 6th ed. Elsevier; 2011.
Steinmetz MP, Benzel EC, eds. Benzel's Spine Surgery. 5th ed. Elsevier; 2022.
Rhee JM, Boden SD, eds. Operative Techniques in Spine Surgery. 3rd ed. Philadelphia: Wolters Kluwer; 2021.

This content is for informational purposes and based on academic sources; consult your physician for diagnosis and treatment.

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Spinal Fractures (Vertebral Fractures)

1Overview

What is this Condition?

Symptoms

Diagnosis Methods

Treatment Methods

References

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