A burst fracture is an injury in which the vertebra, the primary bone of the spine, breaks in multiple directions. The bones of the spine have two main sections. The vertebral arch is a ring-shaped section that forms the roof of the spinal canal and protects the spinal cord. You can feel the spinous process, a projection from this arch, when you press on the skin in the middle of your back. The vertebral body is the cylindrical shaped portion of the vertebral bone that lies in front and provides the majority of structural support. In a burst fracture, the vertebral body shatters. A burst fracture usually results from significant trauma that compresses the bone, such as a motor vehicle accident or a severe fall.
Symptoms
- Moderate to severe back pain that is worse with movement
- Numbness, tingling and weakness
- Loss of bowel or bladder control
Diagnosis
When burst fractures are a result of major trauma, they are usually found as part of a patient’s evaluation in the emergency department of a hospital or medical center. Doctors will need to know how the injury occurred and will perform a comprehensive neurological determine whether deficits exist. The doctor may order X-rays, MRIs (magnetic resonance imaging), and/or CT scans (computed tomography) to better understand the fracture pattern and associated neurologic deficits.
Treatment
A burst fracture is a serious injury; it typically requires immediate hospitalization and treatment. If the burst fracture is not severe, i.e. has not led to neurological and/or structural compromise, then the doctor may initiate a nonoperative approach. However, surgery is required if the burst fracture has significantly impaired the mechanical strength of the spine or causes compression of the spinal cord or nerves, leading to neurological deficits.
The treatment must always be specifically tailored to the patient’s presentation; the choice of procedure will depend on several factors. The surgeon may remove a specific bone that is compressing the spinal cord and nearby nerve roots, which is referred to as a decompression surgery. This surgery relieves the pressure on the spinal cord and nerves by removing the lamina, a procedure known as a laminectomy, or by removing the vertebral body, a procedure known as a corpectomy.
The surgeon is also often required to re-establish the strength of the spine through a spinal fixation and fusion. In these procedures, the surgeon places grafting material in the required space that allows the bones to fuse together. The surgeon also typically inserts implants, such as screws and rods, to hold the spine in place while the bone fuses.