Spinal Fractures

A spinal fracture is a break in one of the vertebrae, the bones that stack up to form the spine. Most people searching for this call it a broken back, and a fractured vertebra, a fractured spine and a broken back all describe the same injury. The bone does not have to break in two: most often the front of a vertebra crumples and loses height, which is called a compression fracture. What matters most with any spinal fracture is why it happened and whether it is stable, because that is what decides how it is treated.

Most spinal fractures fall into two groups. The larger group are fragility fractures, where a vertebra weakened by osteoporosis gives way under everyday load, sometimes with something as minor as a cough, a lift, or a small stumble. These are common: studies estimate around 1.5 million occur each year in the United States, making them almost twice as common as the better-known osteoporotic hip and wrist fractures, and a first one is often the earliest sign that the bones have become fragile. The other group are traumatic fractures, from a high-energy impact such as a car accident, a fall from a height, or a heavy sporting injury.

There are three main routes to a spinal fracture:

• Osteoporosis and fragile bone: as bone loses density with age, and particularly after menopause, a vertebra can fracture under ordinary load. This is the most common cause, and it is why treating the underlying bone weakness is part of treating the fracture itself.
• Trauma: a high-energy impact such as a car accident, a fall from a height, or a heavy landing in sport can break an otherwise healthy vertebra.
• Tumour or infection: less often, a growth or an infection can weaken a vertebra until it breaks, which is one reason imaging is important in making the diagnosis.

An X-ray shows the fracture and any loss of height in the vertebra. A CT scan gives the fine detail of the bone, which matters most for burst fractures, and an MRI can tell a recent, still-painful fracture from an old healed one, show whether the cord or nerves are being compressed, and help rule out a tumour or infection. Where osteoporosis is the likely cause, a bone-density (DEXA) scan measures how fragile the bone is, which guides treatment of the underlying problem.

A spinal fracture, especially a first one from only minor force, is often the moment osteoporosis is finally recognised, so we treat two things at once: the fracture, and the bone weakness behind it, so that the next fracture is less likely. Most of the fractures we see are stable and heal well. The ones that need surgery are the unstable or non-healing fractures, and in fragile bone the priority is fixation that will actually hold. Multiple compression fractures can also round the upper back over time.

Dr. Tayard Buranakarl is a senior spine surgeon at the Bangkok Spine Academy and Bangkok International Hospital, and a Key Opinion Leader for Medtronic. He was the first surgeon in Thailand to introduce the MIS-CAPT technique, a minimally invasive way to stabilise the spine in patients with fragile or osteoporotic bone, and he trains visiting surgeons from across the Asia-Pacific region in minimally invasive spine techniques.