Your spine is a rigid structure which extends from the neck to your pelvis. A fracture or dislocation of a vertebra might cause the bone fragments to compress and damage the nerves in the spine or the spinal cord.
What Are Spinal Injuries?
Any significant trauma to the neck or back which injuries the spinal column and the appendages can be termed a spinal injury. Spinal injuries range from a mild ligament or muscle strain to a fracture or dislocations of the bones in the vertebral column to severe spinal cord fractures. The dislocated bones due to fracture can pinch the nerves or even compress and tear the spinal cord.
The location and the energy causing injury are critical in determining the outcome and the prognosis of the injury. The location of injury at the level of neck are termed cervical injuries.
Cervical Spinal Cord Injury
Of all spinal injuries, cervical injuries are more dangerous and fatal. The Cervical portion of your spine comprises seven vertebrae (C1 – C7) in the neck.In people who carry heavy loads on the head, or in people who get injury to the head, cervical spine is vulnerable. In case of an injury to the cervical area, it may result in tetraplegia/quadriplegia, a condition that limits movement below the cervix or absent feeling. Cervical spine injuries can cause a permanent and complete or partial loss of senses in some parts of the body.
Cervical spine injuries might cause a permanent and complete or partial loss of sensory function and many other associated complications. In the case of spinal cord injuries, that are located high on the spine are most severe, a cervical spinal cord injury can be fatal.
Thoracolumbar fracture is the damage in the vertebrae of your spinal column in the thoracic and the lumbar regions. Usually, injuries to the thoracolumbar spine are caused due to high-energy blunt trauma, which mostly happens in motor vehicle injuries, falls, sports injuries and violence.
TLICS – Thoracolumbar Injury Classification and Severity Scale is the guideline used in the management of thoracolumbar injuries. Of all spinal injuries, 15-20% of them are thoracolumbar injuries.
Depending on the severity of the spinal fractures, you might experience pain, difficulty in walking, or even paralysis to arms or legs. Most of the fractures heal with conventional treatment. However, severe spinal fractures need to be addressed by a spine surgeon because it may require surgery to realign the bones.
The treatment for spinal fractures will depend on the fracture type and the severity of the fracture. Fractures can happen anywhere along your spine. Some stats say that 5 to 10% of fractures occur in the cervical (neck) region and 64% of fractures occur in the thoracolumbar (low back) region.
Types Of Spinal Injury?
Denis Classification method is an excellent method used by doctors to classify a spinal fracture in the region of thoracic, lumbar or thoracolumbar regions of your spine. The method divides the spine into three sections, such as the back, middle and front. Currently, the TLISS ( thoracolumbar injury severity score ) is being used to determine the severity of the injury. Spinal fractures are classified into numerous types. Some of the variants are
Burst fracture: Burst fractures are caused due to severe trauma. They may happen when your vertebra in the cervix, crushed by extreme forces. The fracture is not just in a single part of the vertebra, unlike compression fractures. In a burst fracture, your vertebra gets fractured in many places. Because here in the fractured vertebra might be crushed completely, the fragments of bones spread out and lead to spinal cord injury. Of all the fractures burst fractures are more severe.
Compression Fractures: This is a very common type of fracture seen in people with certain degenerative diseases like osteoporosis, arthritis or people whose bones have weakened due to other diseases such as bone cancer. Even though the vertebra can absorb a lot of pressure; when a sudden force with massive pressure exerts, the bone might not be able to handle the stress, which leads to fracture.
Wedge fracture: It is a subtype of compression fracture where the vertebra, the anterior (front) part mostly collapses under high pressure and becomes wedge-shaped.
Flexion-Distraction Fracture (FDF): The FDF has different names which include chance fracture, extension pattern fracture, seat belt trauma etc. However, the mechanism that causes the fracture is similar.
Fracture-Dislocation: This is a serious type of this injury where the vertebral column is disrupted and one vertebral body slips over another causing a dislocation. This occurs due to severe shear forces or severe flexion-distraction injuries. These are extremely severe injuries, and the patient may suffer from neurological problems like paraplegia or quadriplegia.
These type of injuries are mainly caused due to motor vehicle collision in which the person wearing a seat belt or being hit by a large object in the abdomen or due to falls. Often it involves damage of all the three vertebral columns (anterior, middle, and posterior).
The treatment also depends on the type of fracture, severity. It begins with pain medication and stabilization to prevent further damage. In some cases, bracing and physical therapy can stabilize the fracture, and in severe cases, surgery is required.
Nonsurgical Treatment For Spinal injuries
Initially, an orthopaedic spine surgeon provides conventional treatment when the spinal injury is mild and there is no significant instability.
Braces & Orthotics: They maintain spinal alignment, immobilizes the fractured spine during healing and controls pain as it restricts movement. In case of stable fractures, your spine is stabilized with a brace, such as a rigid collar (Miami J) for cervical fractures and for a cervical-thoracic brace called Minerva for upper back fractures. In case of unstable neck fractures or dislocations, the vertebrae need to be aligned into the correct position.
Surgical Treatment For Spinal Injuries
Surgery for spinal cord injury (SCI) might be performed instantly after injury in severe cases. Immediate surgical intervention in cases of patients with incomplete spinal cord injury and in case of neurologic dysfunction is worsening. The decision of surgery depends on the extent of the injury and extent of instability.
Instrumentation & Fusion: These are surgical procedures that help to treat unstable fractures. Fusion is the procedure of joining two vertebrae with the help of bone graft by holding together with plates, rods, hooks, screws etc. It may take several weeks to months or even longer to fuse the bones together.
These can be also done using the minimally invasive techniques as well. (MISS)
For more information about cervical fractures or if you are suffering from neck pain or any other problems related to your spine, consult our spine specialist Dr Surya Prakash, one the best spine surgeon in Hyderabad.