Tuesday, August 2, 2016
Spinal Fractures: What You Need To Know
Quick Anatomy of the Spine
In order to understand spinal fractures, we must first understand some basic anatomy of the spine, most importantly, the vertebrae. Vertebrae are the stacked butterfly-shaped bones that make up the spinal column. For identification purposes, each of the vertebrae are labeled with a letter and number. This makes it easier for a medical professional to speak about the injury and easier for the patient to understand where the injury has occurred. Spinal injuries can also be classified depending on severity (which will be discussed in detail later). The spine is broken into four categories: cervical spine, thoracic spine, lumbar spine, and sacrum.
> Cervical Spine- The cervical spine is basically your neck. It begins at the base of your skull and ends at about the shoulder blades. There are seven cervical vertebrae labeled C1 through C7. “C” represent cervical and the numbers represent each bone starting from the skull, down. Easy enough.
> Thoracic Spine- The thoracic spine makes up the middle of your back. Most of the thoracic vertebrae are connected to rib bones, making this section relatively stable. There are twelve vertebrae labeled T1 through T12. Again, “T” stands for thoracic and each bone is labeled from the top down. Fractures in the thoracic spine are uncommon. Fracturing of the vertebrae are more likely to occur in the region where the thoracic and lumbar spines meet, called the thoracolumbar.
> Lumbar Spine- The lumbar spine makes up your lower back. Many back-related injuries occur in this section. There are generally five vertebrae in this region, but there can be six and some can be fused with the tailbone. These vertebrae are larger and stronger than the others, but also under more pressure. This section of the back is responsible for carrying a majority of the body weight.
> Sacrum/Coccyx- The sacrum is common referred to as the tailbone. It is made up of four or five vertebrae that are fused into one long bone. It is also considered part of the pelvis.
Types of Spinal Fractures
Several different types of fractures can occur to the spine. They are called: Compression, Burst, Flexion-distraction, and Fracture-dislocation.
> Compression Fracture- A compression fracture is aptly named since it occurs when compression, or pressure, causes the vertebra to cave in on itself. Although this type of fracture is most common in those with osteoporosis, it can occur as a result of trauma. Most compression fractures happen in the lower thoracic region or the upper lumbar region, due to the high amount of stress those sections of the spine carry. There are different sub-types of compression fractures: wedge, crush, and burst (burst fractures will be discussed in-depth later).
o Wedge Fracture- This is the most common form of compression fracture. It occurs when the front of the vertebra (the round cylindrical part) crushes, leaving the back-half of the bone intact.
o Crush Fracture- Unlike the wedge fracture, a crush fracture causes the whole bone to cave in on itself instead of just the front .
> Burst Fracture- A burst fracture occurs when the entire bone is crushed—which is why it’s technically a compression-type—causing it to break out in multiple directions. When the bone bursts, it often sends loose pieces of bone fragments into surrounding tissue and/or the spinal cord. Often, burst fractures are caused by severe trauma like car accidents. This type of fracture is considered severe and requires emergency medical attention.
> Flexion-distraction- Flexion-distraction fractures occur as a result of extreme forward motion on the spine, like those caused in an auto accident. Although the spine is designed to flex forward, a sudden and violent motion forward can cause one vertebra, or multiple vertebrae, to break. Flexion fractures are often the result of a vehicle passenger only wearing a lap seatbelt. Because there is no cross-body strap, the spine is free to move forward. This is one reason why it is so important to wear your seatbelt properly.
> Fracture-dislocation- A fracture-dislocation is not its own unique type of fracture, but instead is something that occurs as a result of both a fracture and movement of the vertebrae. The combination of the two is called fracture-dislocation (much like the name implies). Fracture-dislocations involve all parts of the affected spine and as a result are dangerous and debilitating.
Stable and Unstable Fractures
A spinal fracture can be either stable or unstable. This refers to the spines ability to continue supporting weight. Medical professionals will often categorize a spinal injury into one of these two categories.
> Stable Fracture- With a stable fracture, the spine can still support and carry your weight relatively well, though expectedly, not as well as if there were no fracture. This categorization also refers to a lack of spinal deformity and nerve damage.
> Unstable Fracture- An unstable fracture is obviously the more dangerous of the two. With an unstable fracture, it is difficult for the spine to carry and distribute weight. Fractures categorized as unstable can have spinal deformity, lead to nerve damage, and/or progressively get worse.
Minor and Major Fractures-
> Minor Fracture- A minor fracture is classified as so because of the part of the bone it affects. If a fracture occurs on the back part of the bone (called the posterior, not the main cylindrical part) it is classified as minor. These types of fractures are usually minor because the posterior does not play a major role in spinal stability.
> Major Fracture- A major fracture occurs on the middle or front of the bone—the cylindrical part of the bone. Fractures that occur here are considered major because of the amount weight this part of the vertebra carries. These types of fractures are usually considered unstable and seriousness in nature. There is also a good chance of misalignment and/or nerve damage.