Spinal Fractures: Stability and Treatment Options
Treatment of stable spinal fractures usually involves immobilization using a back brace, brief bed rest, and pain medications as necessary. If the compression is significant, while it may be considered stable and does not require urgent surgical management, surgery may be indicated. This is due to the fact that a significant deformity can result as well as neurologic deficit.
Anterior/Posterior (Front/Back) View:
Burst Fracture, Lumbar Spine
Fractures that leave the spine unstable often include neurologic problems such as paralysis, loss of sensations, and bowel and bladder difficulties. These fractures almost always require surgical interventions that are designed to:
- Stabilize and align the vertebral column
- Improve neurologic status
- Return the patient to functional status as soon as possible
Unstable spinal fractures need to be treated immediately. Many of the same fusion procedures and instrumentation systems (such as rods, screws, and cages) used to treat degenerative spinal conditions are also used to treat these spinal fractures.
Neurologic problems that are the result of a spinal fracture can be devastating and life threatening. Spinal fractures that involve damage to the spinal cord often include serious neurologic injury. Spine specialists differentiate the types of spinal cord injuries by the area of the spine involved and its clinical features. Referred to as syndromes, these include:
Anterior cord syndrome - an injury to the anterior portion of the spinal cord. This injury usually involves paralysis below the level of injury and the loss of pain and temperature sensations. However, patients can usually still feel touch, motion, and vibration and are able to sense the movement of their bodies.
Central cord syndrome - results from swelling in the spinal cord. This most often occurs in the cervical spine and includes difficulties moving and feeling the arms, as well as bowel and bladder dysfunction.
Brown-Sequard syndrome - often the result of penetration injuries such as stab or gunshot wounds, or from spinal cord tumors. This involves loss of movement on one side of the body (the side were the injury occurred) as well as the loss of pain and temperature sensations (on the opposite side of where the injury occurred).
Clinical studies of a steroid called methylprednisolone have been conducted. When given immediately after a spinal cord injury, this steroid medication has the potential to protect neural structures in the spine, possibly limiting paralysis and improving functional outcomes. However, the study has been criticized for its methods, the drug includes numerous adverse side effects, and further research is necessary. Research is also being done on other drug therapies that may provide positive results by improving outcomes in the treatment of spinal cord injuries.