Surgery for Spinal Fractures
Surgery for spinal fractures is very dependent on the type of fracture, if there's neurologic (nerve) injury, and how unstable or out of line the spine is. Because there are multiple factors that go into the surgery decision and because every case has its own set of complications, it's difficult to give precise guidelines of when surgery will be performed and what type of surgery will be done for traumatic spinal fractures.
(This article is focused on spinal fractures caused by trauma. If you'd like to learn more about surgery for fractures caused by osteoporosis or other conditions that weaken the bones, read this osteoporosis article.)
The surgeon will make the best recommendation for surgery: whether you need it and what type of surgery you need. There are several main surgical goals that the surgeon will take into consideration when thinking about surgery:
- restoring spinal alignment
- restoring spinal stability
- reducing neurological complications (removing whatever is pressing on the spinal nerve or spinal cord)
- providing the possibility of rehabilitation (if the surgery can help the patient regain some function, surgery may be a good option)
During the surgery, the surgeon may approach the spine from the front (anterior) or from the back (posterior). It's also sometimes necessary to do an anterior-posterior approach; that's usually for extreme cases of spinal instability and deformity.
To reduce neurological complications, the surgeon may have to remove the parts of the spine that are pressing on the spinal nerves or spinal cord. This is known as a decompression. For example, if a bony fragment is pushing on the spinal cord, the surgeon will remove that.
To stabilize the spine and restore alignment, the surgeon will try to create an environment where the fractured vertebrae and adjacent vertebrae fuse together over time. Usually, a full fusion takes six to nine months. The surgeon will use a bone graft (generally bone from a donor) or a biological substance that will stimulate bone growth. The fusion will provide long-term stability to the spine.
In order to increase stability as the spine fuses, the surgeon may use spinal instrumentation-wires, cables, rods, screws, plates, and cages. These will support the spine until the bones heal fully. After your bones are fully fused, you will not have to have the spinal instrumentation removed.
Spine surgery is not without risks, but your surgeon will make the best recommendation based on the benefits and risks of surgery.