What is a spinal fracture?
Fractures and dislocations of the spine or the backbone are serious injuries because they may be associated with damage to the spinal cord or a condition known as cauda equina. That is why a spine fracture can’t be treated as a broken arm or leg.
FIGURE 1 CURTESY - MAYFIELD CLINIC
Where and how do spinal fractures occur?
The commonest site of injury is the thoracolumbar segment of the backbone. The lower cervical region is the next common site affected. Most spinal fractures are due to falls, sports, car accidents or gunshots.The spinal fracture may be of different severity, froma muscle strain to fracture and dislocation of the vertebrae.
Why is a spinal fracture a serious condition?
Approximately about 20 percent of all spinal injuries result in neurological complications such as a neurological deficit in the form of paralysis of the lower limbs or paralysis of all four limbs. Frequently, the patient does not recover from the deficit, resulting in prolonged paralysis and consequently immobility or at times death.
What are the types of Spinal fractures?
There are different types of spinal fracture;
- Compression fracture- Commonly seen in one with a weak bone. On a lot of pressureandshock, the vertebra may not be able to withstand causing a fracture.
- Burst Fracture- A fracture that occurs after a car accident or severe trauma, where one or more vertebrae is fractured. It is more severe and life-threatening than a compression fracture.
- Flexion-distraction- This occurs when one encounters an accident from behind and the spine is made to flex forward.
- Fracture dislocation- When there is a movement of the vertebra from its normal location
FIGURE 2 CURTESY – BRACE ABILITY
What are the symptoms of a spinal fracture?
Signs and symptoms of a spinal fracture would depend on the severity and location of the fracture. Some of the common symptoms are:
- Back pain
- Muscle spasm
- Neck pain
- Paralysis, in severe cases
- Tingling sensation
What are the investigations performed for a spinal fracture?
Spinal injury is generally treated on an emergency basis, the initial assessment and investigations are done to determine the site and extent of the damage. Some commonly done investigations include;
- Blood tests
- Imaging tests
- Abdominal, Chest and Spine X-ray
- Computed tomography (CT) scan
- Magnetic resonance imaging (MRI)
- Urine test
What are the treatments available?
Before deciding the management strategy, it is crucial to assess the stability of an injured spine. A stable injury is one where intact mechanical linkages prevent further displacement between two vertebral bodies. On the other hand, an unstable injury is the one where further displacement can occur because of serious disruption of the structures responsible for stability. In several cases, it is difficult to decide with utmost surety whether the spine is stable. In such cases of a dilemma, the injuries should be considered as unstable injuries and managed accordingly.
The goals of treatment in spinal fractures are restoring vertebral column stability and obtaining spinal canal decompression, leading to the early mobilization of the patient. Various treatment options include:
- Conservative treatment- Narcotic medication for the management of pain and physical therapy, followed by sufficient bed rest. External support such as a brace may be utilized for initial mobilization, but gradually these are discarded and an active programme of rehabilitation continued till full functions are achieved.
- Conventional surgical techniques- The treatment of choice for unstable injuries is open reduction and surgical stabilization. The conventional surgical treatment includes using internal fixation and arthrodesis. The procedure is carried out under a general anesthesia.
- Instrumentation and fusion- A surgical procedure in which bone fusion is done between two vertebrae with a bone graft held together with the help of rods, plates, pedicle screws or hooks.
- Minimally invasive surgery- This procedure shows a significant advantage over conventional surgical procedure, with fewer complications of blood loss, muscle damage or muscle pain. Vertebroplasty and kyphoplasty are the two types of minimally invasive surgical procedures. In vertebroplasty, a needle is inserted filled with bone cement that is injected in the fractured vertebral body. In kyphoplasty, the compressed vertebra is expanded with the help of a balloon and then the bone cement is injected.
Who can perform spinal surgery procedures?
Spinal surgery is a complicated surgery that requires considerable experience and dexterity. The surgery is usually performed by surgeons who are qualified and experienced in orthopedic surgery. A team of medical professionals led by a neurosurgeon and/or an orthopedic surgeon usually perform the surgery.
Adequate training of surgeons and the effective utilization of the technique is of utmost importance for optimum results with minimal complications.
What happens before, during and after spinal surgery?
Spinal surgery requires careful planning considering the extent of damage and seriousness of the condition. Certain measures that are usually taken before, during and after the surgery include:
- Your medical provider will provide consultation and will review your medical history and current medications. Medications such as blood thinners and non-steroidal anti-inflammatory drugs need to be stopped a week or two before surgery. Smoking, chewing tobacco and drinking are also stopped a week or two before surgery.
- The patient may have to undergo few tests such as blood test, electrocardiogram, chest x-rays, etc.
- The procedure is performed under general anesthesia.
- The patient is positioned on a radiolucent table.
- Using lateral fluoroscopy imaging on the affectedside, a spinal needle is inserted at the level of the involved disc space.
- An incision is then made on one side of the back. Depending on the type of surgery the size of the incision can be small for a minimally invasive surgery of larger for an open surgery.
- A series of dilators are inserted one over the other to gradually separate the muscles and create a channel to the bony vertebra.
- In a minimally invasive surgery, the bone cement is either directly injected into the fractured vertebra or injected after the compressed vertebra has been expanded using a balloon
- The retractors holding the muscles are removed and the skin is then sewn together with sutures or staples.
- The patient is taken to a post-operative recovery center, where blood pressure, heart rate,and respiration are monitored.
- Antibiotics and painkillers may be administered as per clinical protocol.
- The patients are mobilized after the pain subsides and are allowed to be discharged depending on the health status.
What is the rehabilitation process required after spinal surgery?
Spinal surgery is a major surgery which can cause pain and soreness after surgery, therefore, a rehabilitation procedure, which includes physiotherapy and exercises, plays a pivotal role in the recovery from surgery and improvement in the lifestyle of the patient. Common rehabilitation process include;
Pain management- several ways to minimize pain include;
- Correct movement
- Correct posture of the spine
- Electrical devices
- Ice pack application
Exercises- it is an essential step for fast recovery from the surgery. There are three levels of exercise-initial exercise program (normally 4 to 6 weeks after surgery), intermediate exercise program and advanced exercise program. Common exercises include;
- Hip and abdomen strengthening the program
- Leg Raises
- Press Ups
- Regular walk
- Sciatic nerve glide
- Wall squats
Education and training- A physiotherapist will provide sessions on physical therapy, the right way to executing the exercises and postures to maintain after surgery
What are the precautions taken after spinal surgery?
Precautionary measures to be taken after the patient is discharged includes:
- Avoid taking non-steroidal anti-inflammatory drugs and blood thinners
- Avoid sexual activity and exercise
- Take Bed rest
- Driving, smoking, and heavy-lifting is prohibited
- Management of pain and constipation- Spinal surgery is a painful procedure and is managed by giving a potent painkiller for a few This causes constipation and should be managed by drinking a lot of water, high-fiber containing food and a laxative
- Short distance walk is recommended
What complications can be expected after a spinal surgery?
There are few complications that may be encountered aftera spinalsurgery, these include but not limited to the following;
- Bed sores due to bed rest
- Daily activities are disturbed
- Deep vein thrombosis- Formation of a blood clot inside the leg veins
- Injury to neural structures and dural tear- The less common, but more serious, complication of neural tissue is an intraoperative tear of the outer layer of the spinal cord or the dura.If the dural injury is unrecognized or untreated, serious neurological deficits may develop.
- Injury to vascular structures
- Injury to abdominal contents
- Persistent pain
Disclaimer: The shared article is only for awareness and education purpose. Readers are advised to consult their doctor for proper evaluation of the condition and more information. Do not self-medicate.