Human spine is composed of 33 vertebral bones. These bones are attached to each other by ligaments, joints, and pads, in other words discs, between the vertebrae. The spine allows people to stand up straight and to sit down and walk as well as protects the spinal cord and associated nerves inside it. Vertebral fractures have a different significance from other bone fractures because of the risk that nerve structures inside can be affected and surrounding vital vessles and organs can be damaged.
Vertebral fractures in juveniles are often caused by high-energy traumas such as falling from height or traffic accidents. In elderly, vertebral fractures can occur with simple traumas related to osteoporosis and even without a trauma. Of fractures, 5-10% occur in cervical vertebrae, 70% in back and lumbar vertebrae, and the rest in lower parts of the body. The most common injury occurs in the most moving part of the vertebra where back and lumbar vertebrae join to each other.
Vertebral fractures can fall into three categories. The first and most common one is collapsed fractures. Such fractures cause the front part of vertebra to collapse. In more severe injuries, the front and back part of the vertebra can be affected by fracture which is called a burst fracture. Frequency of spinal injury and paralysis is higher in burst fractures than collapsed fractures. If the load on vertebrae is increased further, then the bone can be fractured, and soft tissues, discs and joints connecting and keeping the vertebrae together can be injured. In this case, the connection of two vertebrae is torn, resulting in dislocation of vertebra. This is the most dangerous type of injury where the risk of damage to nerve is the highest.
Various clinical pictures can be observed in patients after a vertebral injury. This varies depending on type of the fracture, severity of the trauma, and affected area of the vertebra. Spinal cord and nerves extending from spinal cord are distributed through the body like electric cables. Healthy function of our organs, senses, or moving are dependent on perfect functioning of this nervous system. Any of these functions in areas under the level where injury has occurred can be damaged in partial or in whole. Fractures and dislocations of cervical (neck) vertebrae can lead to respiratory distress resulting in death or complete paralysis of hands and feet; lumbar injuries can lead to paralysis of legs and complaints about urinary and faecal incontinence.
In general, the first complaint of patients with vertebral fractures is pain. Cervical, back or lumbar pain can be accompanied by muscle spasms. If the fracture is accompanied with a vertebral injury, the complaints can include numbness, loss of sensation in hands-arms and/or legs-feet, loss of strength, urinary and faecal incontinence, and difficulty in urination and defecation. If proper treatment is not administrated to patients with vertebral injury after a fracture, hunch of the spine (kyphosis) can occur, resulting in a severe pain and paralysis.
The elderly may have a history of low back pain or sudden onset back pain which usually not accompanied with a trauma due to vertebral fractures associated with osteoporosis. The pain increases when standing up or walking and reduces when lying down and resting. The movement of spine is restricted; the loss of height occurs in bones, and the pain is unlikely to subside in untreated patients. Neurological problems that may lead to paralysis could appear in patients with progressed collapse of the vertebrae.
It is vital to transport patients suspected with a spinal injury to the nearest healthcare organization. Failure to carry the patients in an appropriate position is one of the most important factors affecting the fatality of injury. The patients delivered to emergency service must be carefully evaluated for concomitant organ injuries, fracture of other areas, and head trauma.
A direct radiography is the first investigation for patients suspected with an injury. Computed tomography (CT) can reveal fractures that are not visible on the direct radiography. It is routinely used at most centers to determine the type and severity of fractures. Magnetic resonance imaging (MRI) is the best method to evaluate the spinal cord and soft tissues. Not only vertebral bones are fractured during a trauma but the ligaments between the vertebrae are often damaged. Displaying these injuries of soft tissue by MRI has an important role in determining the treatment method.
Treatment of spinal injuries varies depending on the type of injury and on whether a spinal injury is present. The purpose of the treatment is to achieve a spine that cannot be damaged by normal physiological forces and to return patients to their usual activities as soon as possible without pain. Only patients with front part of the vertebrae collapsed and whose soft tissues connecting the vertebrae are not affected by the injury can be treated by having a bed rest and corset. Patients in a corset can go back to their daily routine in 10 days. The usage time of a corset ranges between three and six months.
If the injury has caused an unstable fracture or dislocation with fracture, or has resulted in, or poses a risk of a spinal cord injury, surgical methods will be used for treatment. Screws and rods applied from the back are often used in surgical treatment to regain the stability of vertebrae. Placement of the rods can also be performed by close methods where available so that postoperative duration of hospitalization and pain can be minimized. In case of risk of nerve injury or damage, relaxation procedure which is called decompression will be included in the treatment during surgery.
Vertebroplasty or kyphoplasty method is used for fractures associated with osteoporosis. In vertebroplasty, the vertebrae are injected with a bone cement to eliminate the pain and prevent the progression of collapse. In kyphoplasty, the collapse is corrected by inflating a balloon inside the vertebra before cement is injected. Both methods involve radiologic imaging called fluoroscopy and are applied close (without incisions) at our center.
Another treatment method is stent which our clinic has started to utilize for treatment of vertebral fractures at the same time as in the world. In this method, the collapse is corrected by cages placed inside the vertebra without incision. Patients treated by this method can go back to their routine business and activity in a short time without pain.