These fractures may develop unnoticed over a period of time, with no symptoms or discomfort until a bone breaks. There are different types of spinal fractures. Doctors classify fractures of the thoracic and lumbar spine based upon the specific pattern of the fracture and whether there is a spinal cord injury. Classifying the fracture pattern will help your doctor determine the proper treatment.
Thoracic Spine Fracture
Compression fracture. While the front anterior of the vertebra breaks and loses height, the back posterior part of it does not. This type of fracture is usually stable the bones have not moved out of place and is rarely associated with neurologic problems. Compression fractures commonly occur in patients with osteoporosis.
Axial burst fracture. In this type of fracture, the vertebra loses height on both the front and back sides. It is often caused by landing on the feet after falling from a significant height. The vertebra is literally pulled apart distraction.
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This type of fracture can occur in a head-on car collision when the upper body is thrown forward while the pelvis is stabilized by a lap seat belt. Transverse process fracture. This uncommon fracture results from rotation or extreme sideways lateral bending. It does not usually affect stability. These injuries frequently cause serious spinal cord compression. Side view of a fracture-dislocation of a thoracic vertebra.
This MRI scan shows a fracture-dislocation in the thoracic spine. Note the disruption of the spinal cord. A fracture of the thoracic or lumbar spine causes moderate to severe back pain that is worsened with movement. If the fracture is caused by high-energy trauma, the patient may also have a brain injury and lose consciousness, or "black out.
In these cases, it has to be assumed that the patient has a fracture of the spine, especially after a high-energy event such as a motor vehicle crash. Patients with fractures of the thoracic and lumbar spine that have been caused by trauma need emergency treatment. It may be difficult to assess the extent of their injuries on first evaluation.
At the accident scene, EMS rescue workers will first check the patient's vital signs, including consciousness, ability to breathe, and heart rate. After the vital signs are stabilized, rescue workers will assess obvious bleeding and limb-deforming injuries. Before moving the patient, the EMS team must immobilize the individual in a cervical neck collar and backboard. The trauma team will perform a complete and thorough evaluation in the hospital emergency room. The emergency room doctor will conduct a thorough evaluation, beginning with a head-to-toe physical examination of the patient.
This will include an inspection of the head, chest, abdomen, pelvis, limbs, and spine. Neurological tests. The doctor will also evaluate the patient's neurological status. This includes testing his or her ability to move, feel, and sense the position of all the limbs. In addition, the doctor will test the patient's reflexes to help determine whether there has been an injury to the spinal cord or individual nerves.
Fracture of the Thoracic and Lumbar Spine | Fractures, Sprains and Strains
The spinal column is made up of small bones vertebrae stacked on top of one another, creating the natural curves of the back. Between the vertebrae are flat, round, rubbery pads intervertebral disks that act as shock absorbers and allow the back to flex or bend. Muscles and ligaments connecting the vertebrae allow motion while providing support and stability for the spine and upper body. Each vertebra has an opening foramen in the center and these line up to form the spinal canal. Protected by the vertebrae, the spinal cord and other nerve roots travel through the spinal canal.
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Nerves branch out from the spinal column through vertebral openings, carrying messages between the brain and muscles. Facet joints align at the back of the spinal column, linking the vertebrae together and allowing for rotation and movement.
Like all joints, cartilage covers the surface where facet joints meet. The spine contains three segments: lumbar, thoracic and cervical. The lumbar spine consists of five vertebrae located in the lower back; lumbar vertebrae are larger because they carry more of the body's weight. The thoracic spine consists of 12 vertebrae and begins at the upper chest, extending to the middle back and connecting to the rib cage.
The cervical spine includes the neck and consists of seven small vertebrae, beginning at the base of the skull and ending at the upper chest. Disks in the lumbar spine are composed of a thick outer ring of cartilage annulus and an inner gel-like substance nucleus.
What You Should Know About Thoracic Spine Fractures
In the cervical spine, disks are similar but smaller in size. The most common spinal fractures occur in the thoracic midback and lumbar lower back spine, or where the two connect thoracolumbar junction. A spinal fracture is a serious injury, typically caused by an auto crash, fall from height, or other high-velocity accident.
The energy required to severely fracture the spine may also cause spinal cord injury or other damage that requires additional treatment. Men experience fractures of the thoracic or lumbar spine four times more often than women, and seniors who have weakened bone due to osteoporosis are also at increased risk. Fractures of the thoracic and lumbar spine are commonly caused by high-energy trauma, such as an automobile accident, fall from great height, sports accident, or a violent act, such as a gunshot wound. Osteoporosis , tumors, or other underlying conditions that weaken bone can also cause a vertebra to fracture, even during normal, daily activities.
There are several types of thoracic and lumbar spine fractures, and classification is based upon pattern of injury and whether or not the spinal cord has also been injured. Identifying the type of fracture can help your physician determine the most appropriate treatment. The primary symptom of thoracic and lumbar spine fracture is moderate to severe back pain that worsens with movement. Following a high-energy trauma such as an auto accident , the patient may have a brain injury and experience loss of consciousness, and in some instances, the back pain may be overwhelmed by pain from other injuries distracting injuries.
In these cases, emergency responders must proceed under the assumption that a spinal fracture is present. During the initial evaluation, it may be difficult to assess the extent of injuries to patients with fractures of the thoracic and lumbar spine. At the accident scene, EMS rescue workers will determine if the patient is conscious and check vital signs, including heart rate and ability to breathe.
Once these are stabilized, bleeding and injuries demanding immediate attention will be addressed. The patient must be immobilized in a cervical neck collar and backboard before being transported to the hospital emergency room, where a complete evaluation will be performed. Unstable spines can be associated with an increased risk of the neurologic nerve damage. An unstable cervical spine can be associated with an increased risk of the spinal cord damage and can lead to weakness and dysfunction of the arms and legs.
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