Burst fracture
Encyclopedia
A burst fracture is a type of traumatic spinal injury in which a vertebra breaks from a high-energy axial load (e.g., car accidents or falls from a great height or high velocity), with all or pieces of the vertebra shattering into surrounding tissues and sometimes the spinal canal. The burst fracture is categorized by the "severity of the deformity, the severity of (spinal) canal compromise, the degree of loss of vertebral body height, and the degree of neurologic deficit." Burst fractures are considered more severe than compression fractures because long-term neurological damage ensues, whether immediate or increasing impairment of the subject's mobility over time.
with possible paralysis
. X-rays and MRIs are taken to determine whether the burst fracture can be managed with or without surgery. Surgical management is required when the burst fracture is unstable. Different surgical treatments are available, the most common involving fusion of the remaining vertebra in the traumatized area, and removal of the larger loose vertebra pieces. A "spinal fusion
" surgery entails two or more vertebra are permanently immobilized through surgery using titanium implants. Another less common technique is to replace the burst vertebra with an artificial bone or cadaver bone. Both latter strategies have been used successfully in elderly subjects, and has not yet been attempted in younger subjects due to the unknown stability over the long-term.
Nonsurgical management is possible when the burst fracture subject is intact neurologically. Nonsurgical treatment involves the use of a full-body, exterior brace, normally a Thoracic Lumbar Sacral Orthosis (TLSO), often custom-molded to the subject's body. X-rays and MRIs are again taken with the subject every 2 weeks in the TLSO to determine whether the spine will remain stable. The TLSO is worn for 2–3 months 24/7. The subject undergoes several months of physical therapy
to strengthen atrophied muscles and basically learn how to walk again. It is probable that the subject may exhibit some spinal dislocation after removal of the TLSO, and it is well within expected parameters with little neurological impact experienced by month 3. If no further major dislocation or subluxation occurs, no other external stabilization may be required.
, and possible changes in neurological signal intensity with possible deterioration over time. Over the subject's lifetime, the subject experiences ancillary pain and discomfort in the spine and limbs caused by increasing neurological dysfunction.
Treatment
Immediate hospitalization is required, as such injuries may result in varying degrees of spinal cord injurySpinal cord injury
A spinal cord injury refers to any injury to the spinal cord that is caused by trauma instead of disease. Depending on where the spinal cord and nerve roots are damaged, the symptoms can vary widely, from pain to paralysis to incontinence...
with possible paralysis
Paralysis
Paralysis is loss of muscle function for one or more muscles. Paralysis can be accompanied by a loss of feeling in the affected area if there is sensory damage as well as motor. A study conducted by the Christopher & Dana Reeve Foundation, suggests that about 1 in 50 people have been diagnosed...
. X-rays and MRIs are taken to determine whether the burst fracture can be managed with or without surgery. Surgical management is required when the burst fracture is unstable. Different surgical treatments are available, the most common involving fusion of the remaining vertebra in the traumatized area, and removal of the larger loose vertebra pieces. A "spinal fusion
Spinal fusion
Spinal fusion, also known as spondylodesis or spondylosyndesis, is a surgical technique used to join two or more vertebrae. Supplementary bone tissue, either from the patient or a donor , is used in conjunction with the body's natural bone growth processes to fuse the vertebrae.Fusing of the...
" surgery entails two or more vertebra are permanently immobilized through surgery using titanium implants. Another less common technique is to replace the burst vertebra with an artificial bone or cadaver bone. Both latter strategies have been used successfully in elderly subjects, and has not yet been attempted in younger subjects due to the unknown stability over the long-term.
Nonsurgical management is possible when the burst fracture subject is intact neurologically. Nonsurgical treatment involves the use of a full-body, exterior brace, normally a Thoracic Lumbar Sacral Orthosis (TLSO), often custom-molded to the subject's body. X-rays and MRIs are again taken with the subject every 2 weeks in the TLSO to determine whether the spine will remain stable. The TLSO is worn for 2–3 months 24/7. The subject undergoes several months of physical therapy
Physical therapy
Physical therapy , often abbreviated PT, is a health care profession. Physical therapy is concerned with identifying and maximizing quality of life and movement potential within the spheres of promotion, prevention, diagnosis, treatment/intervention,and rehabilitation...
to strengthen atrophied muscles and basically learn how to walk again. It is probable that the subject may exhibit some spinal dislocation after removal of the TLSO, and it is well within expected parameters with little neurological impact experienced by month 3. If no further major dislocation or subluxation occurs, no other external stabilization may be required.
Prognosis
In the long-term, varying degrees of pain, function, and appearance may affect the traumatized region during the subject's lifetime. A burst fracture results in a permanent decrease in anterior height, varying degrees of kyphosisKyphosis
Kyphosis , also called roundback or Kelso's hunchback, is a condition of over-curvature of the thoracic vertebrae...
, and possible changes in neurological signal intensity with possible deterioration over time. Over the subject's lifetime, the subject experiences ancillary pain and discomfort in the spine and limbs caused by increasing neurological dysfunction.
External links
- Information for patients - spinal trauma - Oxford Clinic