Section 5. Bone, Joint, and Muscle Disorders

Chapter 62. Fractures

Topics: Introduction | Foot Fractures | Leg Fractures | Hip Fractures | Fractures of the Pelvis | Fractures of the Spinal Column | Shoulder Fractures | Arm Fractures | Hand Fractures

Fractures of the Spinal Column

In young adults, fractures of the spinal column result from forceful injuries, such as falls from a height, and from motor vehicle and sports accidents. In older people with osteoporosis, compression fractures of the spine can occur with minor trauma or even with lifting, bending forward, or taking a misstep. The cylindrical shaped vertebral body that makes up the forward weight-bearing column of the spine becomes compressed into a wedge shape.

Symptoms and Diagnosis

Spinal fractures cause pain that may worsen with standing, walking, or prolonged sitting. When the doctor gently taps over the spine, the person feels discomfort. Doctors use x-rays to confirm the diagnosis, check the spine for stability, and exclude the possibility of cancer. Because the spinal cord and nerve roots are contained within the spine, the cord or nerve roots may be injured, which may result in a loss of sensation and paralysis. Signs of nerve injury include pain radiating into the leg, weakness of the leg muscles, and involuntary wetting or soiling of clothing.

In older people, compression fractures of the spine sometimes occur suddenly and painfully, and sometimes they occur without symptoms. The result in both cases is a bending forward of the spine (kyphosis) and loss of height. If compression fractures occur over time at several levels of the spine, a person can lose several inches of stature, develop a humpback deformity, and be unable to stand up straight.

Prognosis and Treatment

Great caution is taken with anyone with a possible spinal injury. Accident victims attended by emergency medical technicians are transported using special neck braces and spine boards.

Braces are most effective for fractures located in the lower part of the spine; they can relieve pain and enable the person to more rapidly return to daily activities. Initially, bed rest may be required for a few days, but sitting up and walking for short periods as soon as possible can help prevent loss of function and further loss of bone density.

In older people, compression fractures of the spine that are not complicated by instability, nerve injury, or cancer, heal on their own but slowly. Treatment consists of comfort measures.

See the sidebar Preventing Falls.