What are the other Names for this Condition? (Also known as/Synonyms)

• Spinal-Trauma-Fractures
• Thoracic and Lumbar Spinal Fractures
• Thoracic Compression Fractures

What are Fractures of the Thoracic and Lumbar Spine? (Definition/Background Information)

• A Fracture of the Thoracic and Lumbar Spine is a break or crack that occurs in two of the three vertebral columns of the spine, called the thoracic and lumbar vertebrae. The other vertebral column is the cervical vertebrae
• The most common fractures in the spine occur at the thoracic (mid-back) region, lumbar spine (lower back) region, or at the connection of the thoracic and lumbar vertebral columns (thoracolumbar junction)
• Spinal fractures, also known as vertebral compression fractures, are very common injuries in elderly adults who have osteoporosis; a condition that weakens the bones. These are always serious injuries that require immediate surgical treatment
• The long-term prognosis of Thoracic and Lumbar Spinal Fractures depends on the severity of the injury, the amount of residual deformity, and the extent of neurological damage

There are different types of spinal fractures. Physicians categorize Fractures of the Thoracic and Lumbar Spine based on the injury pattern and if a spinal cord injury has occurred. Categorizing the fracture patterns may help determine the appropriate treatment. Flexion, extension, and rotation are the three major types of spinal fracture patterns. 

Flexion fracture pattern:

• Compression fracture: When the front (anterior) of the vertebra breaks, it partially or fully collapses the vertebra. Compression fractures are usually stable and rarely associated with neurologic disorders. These fractures are usually caused by osteoporosis, trauma, or tumors
• Axial burst fracture: A type of compression fracture that occurs when the vertebra breaks due to high-energy trauma such as a car accident or fall from a significant height. These fractures are usually more serious injuries due to the long-term neurological damage that may result

Extension fracture pattern:

• Flexion/distraction (chance) fracture: These types of fractures occur when the vertebrae are pulled apart, usually as the result of a head-on car accident in which the upper body propels forward, and the lower body stays in place, held by a seat belt

Rotation fracture pattern:

• Transverse process fracture: An uncommon fracture that result from extreme rotation or lateral bending
• Fracture-dislocation: An unstable injury that occurs when a vertebra is displaced from an adjacent vertebra, which frequently severely compresses the spinal cord

Who gets Fractures of the Thoracic and Lumbar Spine? (Age and Sex Distribution)

• Approximately 55% of all vertebral fractures occur in individuals between the ages of 16 to 30 years old
• Fractures of the Thoracic and Lumbar Spine are four times more common in men than women
• The elderly have an increased risk for these fractures, due to weakened bones from osteoporosis
• No ethnic or racial preference is seen

What are the Risk Factors for Fractures of the Thoracic and Lumbar Spine? (Predisposing Factors)

Common risk factors for Thoracic and Lumbar Spine Fractures include:

• Advanced age - the elderly are more prone to Thoracic and Lumbar Spine Fractures
• Participation in any rough or high-impact sport such as basketball or football
• Alcohol intoxication
• Degenerative joint disease (osteoarthritis)
• Chronic inflammatory disorders (such as rheumatoid arthritis)

It is important to note that having a risk factor does not mean that one will get the condition. A risk factor increases one's chances of getting a condition compared to an individual without the risk factors. Some risk factors are more important than others. 

Also, not having a risk factor does not mean that an individual will not get the condition. It is always important to discuss the effect of risk factors with your healthcare provider. 

What are the Causes of Fractures of the Thoracic and Lumbar Spine? (Etiology)

A few common causes of Thoracic and Lumbar Spine Fractures include:

• High-energy traumatic events such as automobile accidents
• A fall from a significant height
• Participation in any rough or high-impact sports such as basketball or football
• Fracture of the vertebra resulting from a gunshot wound

What are the Signs and Symptoms of Fractures of the Thoracic and Lumbar Spine?

Sign and symptoms of Thoracic and Lumbar Spine Fractures may include:

• Moderate to severe back pain that increases with movement
• Tingling sensation, weakness, and noticeable numbness of the spinal cord
• Bowel/bladder dysfunction
• Loss of consciousness due to a brain injury

How are Fractures of the Thoracic and Lumbar Spine Diagnosed?

Diagnostic methods that a physician may use to help diagnose Thoracic and Lumbar Spine Fractures include:

• Physical examination: An emergency room physician will perform a thorough physical examination, starting with a head-to-toe examination of the individual. During the exam, the physician will examine the head, chest, abdomen, pelvis, limbs, and spine
• Neurological tests: The physician will also assess an individual’s neurological status. This includes testing sensory neurons, motor responses, and reflexes, which can determine if the nervous system is damaged. In addition, the physician will test the individual’s reflexes, which can help determine what injury to the spinal cord or individual has occurred
• X-ray of the spine: X-rays are commonly used in evaluating a fracture and to see if the bone has been displaced. This diagnostic imaging test helps provide a clear image of the bone, identify the exact location of the injury, and determine the extent of the fracture
• Computerized tomography (CT) scan of the spine: A CT scan takes a series of x-ray images from several different angles. These images are then merged to create cross-sectional images of bones and soft tissues of the body, which then allows the physician to examine the spine and surrounding structures to confirm the diagnosis
• Magnetic resonance imaging (MRI) of the spine: An MRI is a more detailed scan that uses a magnetic field to generate thorough images of the interior bones and soft tissues to help confirm the diagnosis

Many clinical conditions may have similar signs and symptoms. Your healthcare provider may perform additional tests to rule out other clinical conditions to arrive at a definitive diagnosis. 

What are the possible Complications of Fractures of the Thoracic and Lumbar Spine?

The complications associated with Thoracic and Lumbar Spine Fractures may include:

• Kyphosis (curvature of the spine)
• Abnormal deformity, permanent disability of the spine
• Prolonged chronic pain
• Damage to the nerves or blood vessels within the spine
• Deep venous thrombosis

How are Fractures of the Thoracic and Lumbar Spine Treated?

Treatments for Thoracic and Lumbar Spine Fractures depend on the injury severity, the specific fracture pattern, and the presence of any additional injuries. Once the healthcare professionals have stabilized the individual from any additional life-threatening injuries, the physician will assess the spinal fracture pattern and determine if surgical treatment is required. 

Flexion fracture pattern:

• Any activity that further aggravates the spinal condition should be avoided. The physician would normally advise refraining from all such activities until the symptoms improve and the bone heals
• Complete immobilization of the spine with a cast for 6 to 12 weeks is required to restrict movement
• Individuals are also required to slowly increase physical therapy and rehabilitation exercises. The goals of these exercises are to strengthen the muscles, improve flexibility, and decrease stiffness. It may take several months for an individual to complete a physical therapy program and regain full strength and functionality
• Laminectomy: Laminectomy is a surgical procedure that decompresses the spinal canal and stabilizes the fracture. This procedure involves removing bones and other structures that are compressing the spinal cord

Extension fracture pattern:

• The treatment for extension injuries depends on the result of the injury and if the bone can be reconnected using a brace or cast
• These types of fractures are usually treated non-surgically. Complete immobilization of the spine should be observed closely with a cast or brace for 12 weeks
• If there is an injury to the back (posterior) ligaments of the spine, surgery is usually required. In addition, surgery should also be performed to stabilize the spine if the fracture falls through the disks of the spine

Rotation fracture pattern:

• Transverse process fractures are usually treated by slowly increasing motion, with or without bracing. However, it all depends on the individual’s comfort level
• Fracture dislocations of the thoracic and lumbar spine are generally caused by high-energy traumatic events. These may be very unstable injuries that frequently result in serious spinal cord or nerve damage. Stabilization of the spine through surgery is required. However, surgery may sometimes be delayed due to other serious, life-threatening injuries

How can Fractures of the Thoracic and Lumbar Spine be Prevented?

A few recommendations to help prevent a Thoracic and Lumbar Spine Fracture include:

• Always wear a seat belt when driving or traveling as a passenger in a car
• Individuals who participate in any high-risk sports, such as football or hockey, should wear appropriate safety equipment to help prevent the possibility of any injury or fracture
• Use proper technique when lifting heavy objects
• Avoid any activity that may twist or put abnormal pressure on the spine

What is the Prognosis of Fractures of the Thoracic and Lumbar Spine? (Outcomes/Resolutions)

• The long-term prognosis of Thoracic and Lumbar Spinal Fractures depends on the severity of the injury, the deformity caused, and neurological damage extent
• Even if an individual has surgery to treat a spinal fracture, physical therapy is required in order for an injury to heal
• During physical therapy, the individual will work on decreasing pain, improving range of motion, and returning the individual back to his/her pre-injury level as much as possible

Additional and Relevant Useful Information for Fractures of the Thoracic and Lumbar Spine:

• In the United States every year, approximately 15,000 individuals experience Thoracic and Lumbar Spinal Fractures
• These fractures also account for around 30-60% of all spinal injuries