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Spinal Fractures: Fracture Patterns & Treatment

Spinal fractures are common among athletes, and can have serious consequences. Fans of Brazil’s soccer team know this all too well. Over the weekend, Brazil’s Neymar da Silva Santos Júnior, better known to fans as simply Neymar, suffered from a fractured vertebra during the World Cup game against Colombia. During the game, Colombian player Juan Zuniga attempted to head the ball, causing his knee to collide with Neymar’s lower back. Neymar collapsed to the ground in pain and will now have to sit out the remainder of Brazil’s World Cup games while he heals.

In Neymar’s case, doctors say surgery will not be necessary, and although he will not be able to play for the remainder of the World Cup, he is expected to make a full recovery. However, there are different types of spinal fractures, and treatment will depend on which type of fracture a person has.

Types of Spinal Fractures

Spinal fractures occur most often in the thoracic (mid-back) or lumbar spine (lower back). The spine usually fractures as a result of extreme force, as with a sports accident or auto accident, although the spine can also fracture as a result of weakened bone from conditions like osteoporosis.

Doctors categorize spinal injuries by the pattern of the fracture, and whether the spinal cord was injured by the fracture. Categorizing spinal fractures helps to determine the best course of treatment. There are three main categories that doctors use to categorize fracture patterns: flexion, extension, and rotation.

Flexion fracture patterns may be compression fractures or axial burst fractures. A compression fracture occurs when the front portion of the vertebra breaks, causing the vertebra to compress, or lose height. Axial burst fractures are more severe than compression fractures, occurring when the vertebra fractures in multiple places. Bone fragments from the fracture can come loose and spread out, injuring the spinal cord.

Flexion-distraction fractures are a common extension fracture pattern. Flexion-distraction fractures occur when the vertebra is pulled apart. This type of fracture is often caused by car accidents, when the upper body is pulled forward, while the lower body is held in place by a seat belt.

Rotation fracture patterns can be transverse process fractures or fracture-dislocations. Transverse process fractures are the result of severe bending to the side, but are not very common fractures. Fracture-dislocations occur when a vertebra moves out of place, causing the spine to become unstable. A fracture-dislocation can also severely compress the spinal cord.

Those with a spinal fracture will experience moderate to severe back pain upon injury, and the pain will be worse when attempting to move. If the spinal cord is injured as a result of the fracture, numbness, tingling, or weakness can also occur. In severe cases where the spinal injury is caused by trauma, brain injuries can occur, and the patient may experience a “blackout,” or loss of consciousness.

Treatment of Spinal Fractures

If you suspect someone has a spinal fracture, do not try to move him or her yourself, as this can cause further damage. Wait for emergency responders to arrive. Emergency responders will place the injured person in a neck collar and backboard, immobilizing the patient. Depending on the type and severity of the fracture, different treatment methods may be used.

Flexion fractures can often be treated without surgery, using a brace for six to twelve weeks and rehabilitation. For more serious flexion fractures that put pressure on the spinal cord, a laminectomy may be necessary. A laminectomy involves removing any bone fragments pressing on the spinal cord. Extension fractures can also be treated with a brace if the bones can be fit and held together, but surgery may be needed if there is any damage to the ligaments in the spine, or if the spine is unstable.

Transverse process fractures are often treated with bracing, and patients gradually increase movement until they are comfortable. Fracture-dislocations are usually very unstable, and often require surgery to stabilize the spine. Metal cages, rods, and screws may be used during surgery to restore stability to the spine and fit the bones back together.

Whether surgery is necessary or not, physical therapy is necessary to restore mobility. Recovery can take several weeks, but patients without severe spinal cord injuries are often able to return to pre-injury activities.

It’s critically important to be evaluated properly by a board-certified spinal surgeon. The fracture patterns, as well as the initial management, often will set the stage for proper care during the healing process. Well instability is one indication for surgery, and there are others, as well. Red flags, such as neurologic dysfunction, worsening pain, kyphosis, and other signs, can determine whether or not a spinal fracture can be treated conservatively. Regardless of surgical-versus-nonsurgical treatment, the purpose of any spinal fracture treatment is to restore mobility, optimize neurologic recovery, and allow the healing process to commence immediately without further jeopardizing any other portion of the spine.