What is a vertebral fracture?

The axis of the human body is the spine: it performs important static tasks, serves to protect internal organs and the spinal cord, and allows movement. In healthy people, the spine is highly stable and requires a lot of force to cause a vertebral fracture. The spine is made by seven cervical, twelve thoracic, five lumbar, five fused cruciate and four to five coccyx vertebrae. Together with a complex ligament and muscle apparatus, the spine is therefore a functional, elastic system that can absorb stress.

If vertebral bodies are massively strained from the outside (car, bicycle and motorcycle accidents, plunge into shallow water, fall, sport, violence) a vertebral fracture may be a consequence.  An impact of extreme proportions cannot be absorbed by the muscles. In addition, the spine is often pulled on one side during the fall. The vertebral body strikes and breaks. A vertebral fracture can affect the spinous process, the vertebral body or the vertebral arch.

A vertebral fracture is also called: vertebral body fracture, fracture of the vertebral body, compression fracture, compression fracture, flexion fracture, burst fracture.

In 1994, Friedrich Paul Magerl (born May 21, 1931 in Styria), an Austrian surgeon and pioneer of spinal surgery, introduced a classification for the assessment of injuries to the thoracic and lumbar spine, which is still commonly used for assessment.

Type A: Compression injuries: Here the vertebra is compressed. This happens especially in the front side.

Type B: Distraction injuries: A torque breaks the vertebrae in a transverse direction. Such injuries occur predominantly in the posterior vertebral area.

Type C: Rotation injuries: They occur during a rotation. Even longitudinal ligaments and not infrequently intervertebral discs are affected.

Vertebral fractures - they commonly affect the lumbar spine

Every year 250,000 vertebral fractures occur in Germany. In younger people the main causes are usually traffic and sports accidents, on the other hand, in older people a vertebral fracture is mainly because of a weak bone structure due to osteoporosis. In 20% of accidental fractures, two or more vertebrae are affected. One out of every two patients (54.4%) has an associated injury. And the risk of suffering from a neurological deficit increases significantly with the increasing severity of the injury, with approximately 53% of patients even having myelopathy. Most common are vertebral fractures of the lumbar spine (L-spine) or thoracic spine (T- spine).

Causes of vertebral fracture

The words 'accident' and 'carelessness' keep falling when we talk about traumatic vertebral fractures. Someone fell down the stairs or fell off the ladder. Someone who got punched or jumped into the water without knowing it wasn't deep enough. Someone that in physical education has made an unfortunate somersault on the exercise mat, or someone that has slipped on wet ice or in autumn on damp leaves. There are hundreds of ways to contract a vertebra in an accident (self-inflicted or not). The transitions between the cervical and the thoracic spine, between the thoracic and lumbar spine and between the lumbar spine and the sacrum, are considered particularly prone to be injured.

Apart from traumatic fractures, there are also the so-called pathological fractures such as osteoporosis, bone cancer or skeletal metastases; Spondylitis (bone inflammation), bone softening or necrosis (osteomalacia) and rheumatism. In these cases, the vertebral fracture sets in without a detectable injury.

Vertebral fracture - these are the symptoms

Depending on the location of the fracture, there is pain over the injured vertebral body and adjacent spinal segments. Larger injuries are always associated with considerable painful symptoms. If, for example, the vertebral fracture pinches the spinal cord, it can lead to loss of motor function or impaired sensibility.

However, patients often experience sudden back pain when the spine is injured, often with severe movement restrictions. Depending on the structures involved, emotional disturbances such as tingling or numbness may occur. These can radiate to the arms and legs. In some cases, symptoms of whiplash trauma in the cervical spine may even appear after a few days.

Patients often go to the doctor only when a vertebral fracture presses on surrounding structures. Then the symptoms, such as paralysis in the extremities or disturbances of the sensibility, appear.

Diagnosis vertebral fracture - this is how it can be detected

Diagnostics include the preliminary discussion between doctor and patient - the so-called anamnesis. We keep saying it because we need you to understand that is it important for the diagnosis. Therefore, make sure that the doctor takes his time to listen to you. And take your time too! Tell your specialist if there has been an accident or other potentially triggering event. Tell the doctor if you fell already paralysis, numbness, urinary or bowel movements. He will also question you about pre-existing conditions related to the skeletal system – please answer clearly in order to let the doctor that make a genuinely accurate diagnosis. Because only a precise diagnosis gives him the opportunity to successfully treat you and help you.

Anamnesis is followed by a thorough physical and neurological examination. After the doctor has made a suspected diagnosis on the basis of his investigation, he orders imaging procedures.

With the help of an X-ray, computed tomography (CT) and/or MRI (magnetic resonance imaging), the doctor can look at the vertebral fracture and also clearly recognize what type of fracture and to what extent it actually is. On this basis, doctor and patient decide the further treatment of the vertebral fracture. Further examinations such as bone density measurement or neurophysiological examinations are often necessary.

In the clinical examination, the doctor checks whether walking or standing is possible, a check of mobility in order to establish the presence of possible neurological deficits, cranial nerves, sensibility and motor function are examined.

Basically, the doctor diagnoses either a stable or an unstable vertebral fracture. In stable fractures, soft tissues and ligaments are unaffected, and the spinal canal is not constricted. Fortunately, about 85% of all spinal fractures are stable fractures and they can sometimes heal again without surgery.  An unstable vertebral fracture occurs when the affected spinal column has been deformed by forces that act from different directions. These include, for example, distraction injuries (type B) and rotational injuries (type C). An unstable vertebral fracture can lead to paraplegia, if not treated.

Successful treatment of a vertebral fracture depends on many factors

The therapy varies between immobilization and physiotherapy up to interventions such as stabilization, vertebral body replacement or kyphoplasty, including cage (placeholder) implantation.

The treatment is then decided depending on the severity of the fracture on one or more vertebral bodies. Slight upset vertebrae, soft tissue injuries and smooth, stable fractures usually do not require surgery. There are, depending on the injury, good chances of recovery with conservative therapies that include immobilization, massages, physiotherapy, warmth, or cold treatments.

In some cases vertebral body replacement or a combination of the above procedures is necessary. Which method is most suitable in the individual case depends on the type of injury (such as stable or unstable fracture) and also on the age of the patient.

In a complicated vertebral fracture with shifted fracture edges or splinters, we have various operations available. With the help of microsurgery, we relieve the neural (nerve) structures. Sometimes also stabilization measures (spondylodesis) are necessary. Here we make a block (stiffening, fusion, and plating) of the affected spinal column section but other treatment options are also possible here.

The goal of surgical treatment is to quickly reorient and stabilize the spine to relieve pressure on the nerves as quickly as possible.

Prognosis - live painless after a vertebral fracture

Unfortunately, it is not possible to do a clear prognosis after suffering from vertebral fracture. And it would also be irresponsible if we did not say it so clearly. A bit of luck and - of course - a back-friendly behavior is part of it. Basically, one can say: The healing time of a vertebral fracture depends on how severe the injuries were. A stable vertebral fracture usually becomes bony again after a few weeks or months without moving further. So they come back to their feet relatively quickly, and into the corridors, and ideally will be able to live without any consequential damage.

The healing time after an unstable vertebral fracture can take up to six months or more. Unfortunately, one has to say that, despite a good course of healing, pain and decreased mobility may persist. The process of healing of a vertebral fracture is very different in each case. Many factors such as age, extent of injury and subsequent treatment influence the recovery.

That's why you need to take care of yourself! Anyone who practices high-risk sports should always wear the correct protective clothing. After all, it's not a secret that motorcycling, snowboarding and show jumping for example pose a high risk of a vertebral fracture. Motorcyclists should NEVER start their ride without the proper protective clothing but anyway, high-risk sports, putting on so-called back protectors can often prevent bad things.

Dr. med. Munther Sabarini

Author
Dr. med. Munther Sabarini
Specialist in Neurosurgery

Hans-Heinrich Reichelt

Co-author
Hans-Heinrich Reichelt
Chief Editor of Medizin für Menschen

The Avicenna Clinic in Berlin is always willing to help you

Since the year 2001, the Avicenna Clinic is based in Berlin. Our doctors have at least 25 years of international experience in their respective fields (neurosurgery, spinal surgery, anesthesia, and orthopedics).

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