Spinal Fractures: Symptoms, Types, Causes and Treatment

Spinal fractures are a significant medical concern, affecting people of all ages and backgrounds. Whether resulting from high-energy trauma like car accidents or low-impact events such as a simple fall in the elderly, these injuries can have lasting consequences. Understanding the symptoms, types, causes, and available treatments is crucial—not only for patients and their families but also for healthcare professionals making critical decisions. This article provides an in-depth, evidence-based overview of spinal fractures, drawing on the latest research and clinical guidelines.

Symptoms of Spinal Fractures

Recognizing spinal fracture symptoms early can be life-saving. The symptoms vary depending on the location, severity, and type of fracture, as well as whether the spinal cord or nerves are involved. While some fractures cause immediate, severe pain, others may be more subtle, particularly in the elderly or those with underlying conditions.

Main Symptom	Description	Red Flags/Complications	Source(s)
Pain	Sudden, severe back or neck pain	Worsened with movement	1 7 12
Neurological	Numbness, tingling, weakness	Paralysis (paraplegia, tetraplegia)	2 3 7
Deformity	Visible spinal deformity, loss of height	Kyphosis, hunchback posture	12 15
Associated Injuries	Other injuries (head, limbs)	Indicate high-energy trauma	3 7 8 9

Table 1: Key Symptoms of Spinal Fractures

Pain: The Most Common Warning Sign

• Sudden, localized pain in the back or neck is the hallmark symptom of a spinal fracture.
• The pain often intensifies with movement, standing, or walking, and may be relieved by lying still.
• In osteoporotic or low-impact fractures, pain may be less dramatic and develop gradually, sometimes being mistaken for muscle strain or arthritis flares 7 12.

Neurological Symptoms: When Nerves Are Involved

• Spinal fractures can compress or damage the spinal cord and nerve roots.
• Symptoms include numbness, tingling, muscle weakness, or even complete loss of movement and sensation (paraplegia or tetraplegia) below the site of injury 2 3 7.
• Loss of bladder or bowel control can occur, indicating urgent medical attention is needed.

Physical Deformity and Loss of Height

• Some fractures—especially compression fractures—cause visible deformity, such as a hunched posture (kyphosis) or loss of height 12 15.
• In severe cases, a step-off or abnormal curve may be felt or seen along the spine.

Associated Injuries

• Because spinal fractures often result from high-energy events, injuries to other body parts (head, chest, pelvis, limbs) are common 3 7 8 9.
• The presence of these injuries increases the likelihood of more severe spinal damage and neurological deficits.

Types of Spinal Fractures

Spinal fractures are classified by their pattern, mechanism, stability, and the region of the spine involved. Understanding the type of fracture helps guide treatment and predict outcomes.

Fracture Type	Description	Stability/Neurological Risk	Source(s)
Compression	Collapse of vertebral body (wedge)	Usually stable, low risk	2 3 12
Burst	Vertebral body shatters outward	Can be unstable, moderate-high risk	2 3
Flexion-Distraction	Vertebrae pulled apart (e.g., seatbelt injury)	Often unstable, risk of nerve injury	2 4 14
Fracture-Dislocation	Bone and joints displaced	Highly unstable, high risk	2 3
Osteoporotic	Low-energy, often compression	Varies, risk in elderly	7 10 12
Pathological	Due to tumor, infection, or disease	Often unstable, high risk	1 7 10
Ankylosed Spine	In stiff spines (e.g., ankylosing spondylitis)	Unstable, high risk	5 11

Table 2: Major Types of Spinal Fractures

Compression and Burst Fractures

• Compression Fractures: Most common, especially in osteoporotic bones. The front part of the vertebra collapses, forming a wedge shape. Typically stable and less likely to cause nerve damage 2 3 12.
• Burst Fractures: Involve the entire vertebral body, which shatters outward. Can compress the spinal cord or nerves and are often unstable 2 3.

Flexion-Distraction and Fracture-Dislocations

• Flexion-Distraction (Chance) Fractures: Result from the spine being pulled apart, often seen in car accidents with lap belt injuries. These are often unstable and require careful assessment 2 4 14.
• Fracture-Dislocations: Both bones and supporting ligaments/joints are disrupted, causing the spine to become misaligned. These are highly unstable and frequently associated with neurological injury 2 3.

Osteoporotic and Pathological Fractures

• Osteoporotic Fractures: Occur in weakened bones, often after minimal trauma. Compression fractures are most common, with a risk of deformity and chronic pain 7 10 12.
• Pathological Fractures: Caused by underlying diseases such as tumors or infections. These fractures are often unstable and require specialized management 1 7 10.

Ankylosed Spine Fractures

• Occur in patients with ankylosing spondylitis or diffuse idiopathic skeletal hyperostosis (DISH).
• The stiff, brittle spine fractures easily, even after minor trauma, and these injuries are often unstable with a high rate of neurological complications 5 11.

Causes of Spinal Fractures

Understanding what leads to spinal fractures is key for prevention and early detection. The causes range from major traumatic events to underlying health conditions that weaken the bones.

Cause	Typical Patient/Scenario	Notes on Risk	Source(s)
High-Energy Trauma	Falls from height, car accidents	Common in younger adults	3 8 9
Low-Energy Trauma	Simple falls, especially elderly	Often with osteoporosis	7 8 12
Disease/Pathology	Tumors, infections (e.g., TB), osteoporosis	Weakens bone structure	1 7 10 12
Ankylosed Spine	Ankylosing spondylitis, DISH	Fractures from trivial injury	5 11
Risk Factors	Age, corticosteroid use, prior cancer, spinal OA	Increase risk	1 10 12

Table 3: Main Causes and Risk Factors for Spinal Fractures

Trauma: High and Low Energy

• High-Energy Trauma: Young and middle-aged adults are most often affected by falls from height, traffic accidents, or sports injuries. These incidents typically produce severe fractures, often involving multiple vertebral levels and associated injuries 3 8 9.
• Low-Energy Trauma: In older adults, even a minor fall or simple movement can cause a fracture due to osteoporosis or pre-existing spinal disease 7 8 12.

Underlying Disease and Pathological Fractures

• Bone-weakening conditions such as osteoporosis, metastatic cancer, spinal tuberculosis, or chronic steroid use can lead to "pathological" fractures, even without significant trauma 1 7 10 12.
• Postmenopausal women are especially at risk due to the high prevalence of osteoporosis and spinal osteoarthritis 10 12.

Ankylosed and Stiff Spines

• Individuals with ankylosing spinal disorders (e.g., ankylosing spondylitis, DISH) develop a rigid, brittle spine that is highly susceptible to fracture—even from trivial incidents 5 11.
• Diagnosis may be delayed and outcomes are often worse due to frequent neurological complications.

Key Risk Factors

• Older age: Bone density decreases with age, raising fracture risk 1 7 10.
• Corticosteroid use: Long-term use weakens bone 1.
• Prior cancer history: Raises suspicion for pathological fractures 1.
• Spinal osteoarthritis: Increases fracture risk, even with normal bone density 10.

Treatment of Spinal Fractures

Treatment of spinal fractures is tailored to the type, severity, stability, and presence of neurological deficits. Options range from conservative management to complex surgical interventions.

Treatment Type	Indication	Main Goal	Source(s)
Conservative	Stable, no nerve injury	Pain control, mobilization	2 12 14 15
Bracing	Mild-moderate compression fractures	Support healing, reduce pain	2 12
Vertebral Augmentation	Persistent pain, select cases	Pain relief, restore height	12 13 15
Surgical Fixation	Unstable, neurological deficit	Stabilize spine, decompress nerves	2 5 6 14
Disease Management	Osteoporosis, tumor, infection	Treat underlying cause	10 12

Table 4: Main Treatment Approaches for Spinal Fractures

Conservative (Non-Surgical) Management

• Rest and Pain Control: Most stable fractures without nerve involvement are managed with rest, pain medication (NSAIDs, acetaminophen), and gradual mobilization 2 12 14 15.
• Bracing: Supports the spine during healing, particularly in compression fractures 2 12.
• Physical Therapy: Aims for early mobilization, muscle strengthening, and prevention of complications.

Vertebral Augmentation

• Vertebroplasty and Kyphoplasty: Minimally invasive procedures where bone cement is injected (sometimes after balloon inflation) to stabilize the fracture and relieve pain 12 13 15.
• Evidence: Kyphoplasty may improve pain and function, but routine vertebroplasty is not recommended due to limited benefit and potential risks 13 15.
• Indication: Generally reserved for patients with persistent pain after conservative therapy and no neurological deficits.

Surgical Management

• Indications: Unstable fractures, neurological compromise, multi-level injuries, or in patients with ankylosed spines 2 5 6 14.
• Procedures: Options include posterior or anterior fixation (using rods, plates, or screws), decompression of nerves, and sometimes fusion of affected segments 2 5 6 14.
• Evolving Techniques: Minimally invasive posterior percutaneous fixation is increasingly favored for certain burst fractures without severe nerve injury 6.
• Special Considerations: Patients with osteoporosis or ankylosed spines require careful surgical planning due to poor bone quality and higher complication rates 5 11.

Treating Underlying Disease

• Osteoporosis Management: Calcium, vitamin D, bisphosphonates, and sometimes calcitonin or other agents are used to improve bone strength and reduce future fracture risk 10 12 13.
• Cancer or Infection: Requires multidisciplinary care, including oncology or infectious disease specialists, and sometimes surgery 1 7 10 12.

Decision-Making and Individualization

• No single treatment fits all; decisions are based on the patient's overall health, clinical presentation, fracture characteristics, and personal goals 14.
• A multidisciplinary approach is often needed.

Conclusion

Spinal fractures are complex injuries with a wide spectrum of causes, presentations, and treatments. Rapid recognition and appropriate management can make a critical difference in outcomes. Here’s a summary of the main takeaways:

• Typical symptoms include sudden pain, neurological changes, deformity, and possible associated injuries.
• Types of fractures range from stable compression to unstable burst and fracture-dislocations, with special groups like osteoporotic and ankylosed spine fractures.
• Causes include high-energy trauma, low-impact falls in the elderly, underlying diseases, and specific risk factors like osteoporosis or chronic steroid use.
• Treatment is highly individualized, from conservative measures (rest, bracing) to advanced surgical interventions, with vertebral augmentation available for select cases.

Staying informed about the risks, recognizing red flags, and seeking prompt medical care can help minimize complications and support recovery from spinal fractures.