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Understanding Spinal Trauma

Spinal fractures or vertebral fractures usually occur in two different populations of patients. They can occur in an elderly osteoporotic person with very little trauma, or they can occur in a younger person after a more major trauma, like a car accident, falling from a height, skiing accident...

Vertebral fractures can occur in any region of the spine. The most frequently affected regions are the bottom part of the neck (cervical spine) and in the lower back (upper lumbar spine) area. Again, depending on the amount of force involved in the traumatic event, the amount of damage to the vertebrae varies.

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 Spinal Fractures

Injuries to the cervical spine can result in quadriplegia (paralysis of all four limbs). In contrast, thoracic or lumbar spine injuries can result in paraplegia (paralysis of the lower limbs). The location and severity of the damage determine the extent of neurological deficits and the overall prognosis.

Articles of Interest

The Value of X-ray Compared with Magnetic Resonance Imaging in the Diagnosis of Traumatic Vertebral Fractures

Most of the existing studies on diagnosis of vertebral fractures are limited to non-traumatic pathologic fractures and few studies have been conducted on traumatic fractures. Despite standardization of radiographic reading, in approximately half of hospitalized elderly patients, moderate to severe vertebral fracture could not be diagnosed, according to a retrospective study.

A Clinical Decision Rule for Thoracic and Lumbar Spine Fractures: Does the NEXUS Rule Work Below the Neck?

When modified for T- and L-spine tenderness, the NEXUS rule has very good sensitivity (>90%) for identifying spinal injuries below the neck. Caution may be warranted when applying this rule in older patients.

Compression Fractures of the Spine

VCFs may result from osteoporosis, malignancy, infection, or trauma. Among these, osteoporosis is the most common cause of VCFs.

EM@3AM: Sacral fractures

A full neurologic exam, specifically aimed at the lower nerve roots (L5-S5), is needed to find any deficits. CT may be needed to discover if there is a fracture; x-rays have poor sensitivity.

Innovative Spinal Treatments to Get Back in the Game

Most spinal fractures are compression injuries. This means that the affected vertebra is pushed down and compressed. If enough force is present, pieces of the vertebra can end up in the spinal canal, which is the space that houses the spinal cord. The vertebra can also be dislocated, or pushed out of its alignment.

Lumbar Compression Fracture

Most of the fractures occur at the thoracolumbar junction. This is a transition zone (T12-L2): the thoracic vertebrae are more rigid in compare to the mobile lumbar region which means that the transition zone receives the biggest load during impacts.

Management of vertebral fragility fractures

Vertebral fragility fractures (VFFs), mostly due to osteoporosis, are very common and are associated with significant morbidity and mortality. There is a lack of consensus on the appropriate management of patients with or suspected of having a VFF.

Physician use of red flags to screen for fractured vertebrae for patients with new back pain

Eight studies including several thousand patients described 29 different questions and physical exam tests that have been used to look for spinal fractures. Most of the 29 were not accurate. The best four questions asked about use of steroids (which can cause weak bones), the patient’s age (age above 74 increases the risk of fractures) and recent trauma such as a fall. Using a combination of the best questions appears to improve the accuracy. For example, women above age 74 are more likely to have a fracture when they come to the physician complaining of back pain. In the emergency room, the best indication of a spinal fracture was a bruise or scrape on the painful area of the back. Fractures are rare and generally do not require emergency treatment...

Thoracolumbar Spinal Injuries in Blunt Trauma...

TLS injuries are common in blunt trauma patients. Screening for these injuries is imperative owing to the devastating impact that unrecognized fractures and resultant spinal cord injuries can have on patient outcomes. The indications to scan patients with back pain, point tenderness, neurologic deficit, altered mental status, multiple or distracting injuries, or the presence of other spinal fractures are evident and well documented

Unstable spine fractures

Jefferson's fracture. Bilateral Cervical facet dislocation.m Odontoid fracture, type II or III...

Vertebral Fractures in Pediatric Suicidal Jumpers: A Retrospective Study with Epidemiological and Clinical Analysis before and after the COVID-19 Pandemic

This study shows an exponential increase in pediatric vertebral fractures due to suicide jumping attempts after the COVID-19 pandemic. These are high-energy fractures that are rather unusual in adolescents, and rarely observed in specific cases (such as spinopelvic dissociation).