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A spinal fracture occurs when one or more bones in the spine (vertebrae) break due to trauma or underlying conditions that weaken the bone, such as osteoporosis or tumours. These fractures can range from minor fractures that heal with conservative treatment to severe fractures that require surgical intervention. Spinal fractures are commonly classified based on the part of the spine affected: cervical (neck), thoracic (mid-back), or lumbar (lower back).

Key Causes of Spinal Fractures

• Trauma: High-energy trauma such as road traffic accidents, falls from heights, or sports injuries.
• Osteoporosis: Weakening of the bones due to reduced bone density, commonly leading to compression fractures in the elderly.
• Pathological Fractures: Fractures caused by bone tumours, metastatic cancer, or infections (e.g., osteomyelitis).

Clinical Presentation

• Pain: Severe, localized back pain, often worsening with movement.
• Neurological Symptoms: Depending on the location and severity, fractures may cause numbness, tingling, weakness, or paralysis if spinal cord injury occurs.
• Spinal Deformity: Kyphosis (hunchback) or abnormal spinal alignment may occur in severe fractures.
• Loss of Mobility: Difficulty walking or performing activities due to pain and instability.

Diagnosis

• History and Physical Examination: Assess the mechanism of injury, pain, and neurological status.

Imaging

• X-ray: The initial imaging modality to visualize fractures.
• CT Scan: Provides detailed images of the bone and helps assess the extent of the fracture.
• MRI: Useful in evaluating spinal cord injuries, ligament damage, and soft tissue involvement.

Management

• Conservative Treatment:
  • Indicated for stable fractures with no neurological involvement.
  • Includes bed rest, bracing (e.g., cervical collar, thoracolumbar brace), pain management, and physical therapy.
• Surgical Treatment:
  • Required for unstable fractures, fractures with neurological impairment, or those that do not respond to conservative treatment.
  • Procedures may include spinal fusion, vertebroplasty, or kyphoplasty to stabilize the spine.
• Rehabilitation: Physical therapy and rehabilitation are critical components of recovery, especially in patients with spinal cord injuries.

Table: Classification and Management of Spinal Fractures

Type of Fracture	Common Causes	Clinical Features	Diagnosis	Treatment
Compression Fracture	Osteoporosis, trauma	Back pain, kyphosis	X-ray, MRI (if neurological involvement)	Conservative: bracing, pain management
Burst Fracture	High-energy trauma	Severe back pain, potential neurological deficits	CT scan, MRI	Depends on stability; surgical stabilization may be needed
Chance Fracture	Seatbelt injury, flexion-distraction trauma	Back pain, possible neurological symptoms	X-ray, CT scan	Often requires surgery due to instability
Fracture-Dislocation	Severe trauma (e.g., car accidents)	Severe pain, significant neurological deficits	MRI, CT scan	Surgical emergency to prevent further spinal cord injury
Pathological Fracture	Cancer, infection, osteoporosis	Persistent pain, may present with minimal trauma	X-ray, MRI, bone biopsy (if cancer suspected)	Treat underlying cause, bracing, possible surgery