What are Traumatic Spinal Fractures?

Traumatic spinal fractures are breaks in the bones of the spine caused by an injury. These fractures may involve the cervical spine in the neck, thoracic spine in the mid back, lumbar spine in the lower back, or the sacrum near the pelvis.

A traumatic spinal fracture may be stable or unstable. A stable fracture may not significantly affect spinal alignment or nerve structures. An unstable fracture may involve abnormal spinal motion, deformity, compression of the spinal cord or nerve roots, or injury to the ligaments that support the spine.

De Novo Brain & Spine evaluates adult patients with traumatic spinal fractures when symptoms or imaging suggest spinal instability, nerve compression, spinal cord compression, deformity, burst fracture, fracture-dislocation, compression fracture, or another spine trauma-related condition that may require neurosurgical review.

Common Signs and Symptoms

Traumatic spinal fracture symptoms depend on the fracture location, injury mechanism, spinal stability, and whether the spinal cord or nerve roots are affected.

Common signs and symptoms may include:

• Sudden neck pain, mid back pain, or low back pain after trauma
• Moderate to severe pain that worsens with movement
• Pain after a fall, motor vehicle accident, sports injury, work injury, or direct impact
• Tenderness over the injured spinal level
• Muscle spasms or stiffness
• Difficulty standing, walking, sitting upright, or changing positions
• Pain that travels into the shoulder, arm, hand, buttock, leg, or foot when nerves are affected
• Numbness or tingling in the arms, hands, legs, or feet
• Weakness in the arms, hands, legs, ankles, or feet
• Balance problems or trouble walking
• Loss of coordination
• Visible deformity or abnormal posture in selected cases
• Loss of bowel or bladder control in severe cases
• Symptoms of spinal cord injury, including weakness, sensory loss, or paralysis

Seek emergency medical care or call 911 for severe neck or back pain after trauma, weakness, numbness, tingling, trouble walking, loss of coordination, bowel or bladder changes, loss of consciousness, head injury, or any concern for spinal cord injury. Do not move a person with suspected serious spine trauma unless necessary for safety.

What Causes This Condition?

Traumatic spinal fractures are caused by force that exceeds the strength of the spinal bones and supporting structures. The injury may involve compression, bending, twisting, distraction, direct impact, or a combination of forces.

Possible causes and related factors may include:

• Motor vehicle accidents
• Motorcycle, bicycle, or pedestrian accidents
• Falls from height
• Ground-level falls, especially in older adults or patients with weaker bones
• Sports injuries
• Work-related or construction-related trauma
• Direct blow to the spine
• Physical assault or violence
• Penetrating trauma in selected cases
• High-energy twisting or flexion-extension injury
• Burst fracture, where a vertebra breaks under compression and may affect the spinal canal
• Flexion-distraction injury, sometimes called a Chance-type injury
• Fracture-dislocation, where fracture occurs with abnormal displacement or instability
• Osteoporosis or low bone density, which can increase fracture risk even with lower-energy trauma

These causes and risk factors do not mean every spinal fracture is unstable or requires surgery. Treatment planning depends on the injury mechanism, fracture pattern, spinal alignment, neurological examination, imaging findings, bone quality, and overall health.

How It Is Diagnosed?

Traumatic spinal fractures are diagnosed through trauma history, physical examination, neurological examination, and imaging. Evaluation is often urgent because some fractures can affect spinal stability, the spinal cord, or nerve roots.

Common diagnostic steps may include:

• Emergency or trauma assessment to evaluate injury mechanism, pain location, other injuries, vital signs, and neurological status
• Medical history and medication review to identify blood thinner use, osteoporosis, prior spine surgery, cancer history, or other relevant medical factors
• Physical examination to evaluate spinal tenderness, deformity, muscle spasm, painful movement, and signs of associated injury
• Neurological examination to assess strength, sensation, reflexes, coordination, gait when safe, rectal tone when clinically appropriate, and signs of spinal cord or nerve root involvement
• X-rays of the spine to evaluate alignment, fracture, deformity, and vertebral height loss in selected cases
• CT scan of the cervical, thoracic, or lumbar spine to evaluate bone detail, fracture pattern, spinal canal involvement, displacement, and surgical planning
• MRI of the spine when spinal cord injury, nerve compression, ligament injury, disc injury, epidural hematoma, infection, tumor, or soft-tissue injury is suspected
• CT angiography, also called CTA, in selected cervical spine trauma cases when injury to a vertebral artery or other blood vessel is suspected
• Standing or upright X-rays in selected stable fractures when alignment under weight-bearing needs evaluation
• Full-spine or additional imaging when multiple injuries, deformity, or noncontiguous spinal fractures are suspected
• Blood tests in selected trauma cases to evaluate blood count, clotting, infection concern, metabolic issues, or surgical readiness

The goal of diagnosis is to identify the fracture type, determine whether the spine is stable, assess whether the spinal cord or nerve roots are affected, and decide whether bracing, monitoring, surgery, or urgent stabilization may be appropriate.

Treatment Options

Traumatic spinal fracture treatment depends on the fracture location, fracture pattern, spinal stability, spinal alignment, neurological examination, imaging findings, other injuries, bone quality, pain severity, and overall health. Not every traumatic spinal fracture requires surgery.

Treatment options may include:

• Emergency stabilization and trauma care when the injury is severe or associated with other injuries
• Spinal precautions or immobilization during initial evaluation when instability is possible
• Pain control when medically appropriate
• Activity modification to avoid movements, lifting, bending, twisting, or positions that worsen pain during healing
• Bracing in selected stable fractures to support the spine while the fracture heals
• Observation with repeat imaging for selected stable fractures without neurological deficit or progressive deformity
• Physical therapy and rehabilitation after the appropriate healing period to improve mobility, strength, balance, posture, and safe movement
• Treatment of osteoporosis or low bone density when bone weakness contributes to fracture risk
• External immobilization, such as a cervical collar or thoracolumbosacral orthosis, when appropriate for the fracture type
• Surgical decompression when bone, disc, hematoma, or deformity compresses the spinal cord or nerve roots
• Spinal fusion or stabilization when the fracture is unstable, displaced, associated with ligament injury, or causing progressive deformity
• Instrumentation with screws, rods, plates, or cages in selected cases to restore alignment and stabilize the spine
• Corpectomy in selected cases when a damaged vertebral body must be removed to decompress the spinal cord or reconstruct the spine
• Minimally invasive stabilization in selected fracture patterns when anatomy and surgical goals support that approach
• Treatment of associated spinal cord injury with urgent medical, surgical, and rehabilitation planning when present
• Rehabilitation and follow-up care to monitor healing, alignment, pain, neurological function, mobility, and return to activity

Surgery is not appropriate for every traumatic spinal fracture. Neurosurgical treatment may be considered when a fracture causes spinal instability, spinal cord compression, nerve compression, progressive deformity, neurological symptoms, fracture-dislocation, burst fracture with canal compromise, or failure of appropriate non-surgical treatment.