Overview

A “broken back” is another term to describe a spinal fracture — a break in one or more vertebrae, the 33 bones that form your backbone and protect your spinal cord. A broken back injury can be worrying, but it doesn’t necessarily mean that there’s damage to the spinal cord.

A bad fall is the most common cause of a broken back. A traumatic injury from a car accident or other collision may also result in a spinal fracture. But other conditions, such as osteoporosis (weak or brittle bones) and spinal tumors, can also lead to vertebral fractures.

A bacterial or fungal infection of the vertebrae may weaken the bones enough to cause a fracture. Malnutrition, a weakened immune system, cancer, and obesity may also raise your risk of fracture.

What are the symptoms?

Severe pain at the site of the fracture is the main symptom of a broken back injury. If back pain is made worse when you move, that’s also a sign that a vertebra may have been broken.

If, however, the broken bone compresses the spinal cord’s other nerves, there may be numbness as well as pain. Your reflexes and muscle strength may also be affected if nerve roots or the spinal cord was injured, too. Nerve damage can also lead to bladder and bowel problems.

There are three main patterns of spinal fractures. Each one can have its own set of symptoms. The three patterns are flexion, rotation, and extension.

Flexion

Your spine is meant to bend or flex forward, but certain types of fractures can restrict your spine’s ability to bend. Two examples are compression fractures and axial burst fractures.

A compression fracture occurs when the front of a vertebra breaks and loses a little of its height, but the back of that vertebra remains intact. Symptoms include pain in the back and sometimes in the arms or legs. Numbness in the limbs can occur if the spinal cord is harmed. Over time, a compression fracture can make you slightly shorter.

An axial burst fracture occurs when height is lost on both the front and back side of a vertebra. The symptoms are similar to that of a compression fracture. The pain with an axial burst fracture can be especially intense when you move.

Rotation

Rotation fracture patterns include a transverse process fracture and a fracture-dislocation.

Each vertebra has two transverse processes. These are extensions on either side of the bone that connect to ligaments and muscle. If all or part of a process chips off during a broken back injury, the result can be quite painful.

However, the spinal cord is usually unaffected, meaning no numbness or weakness. The stability of the spine remains secure. A transverse process fracture is rare. It’s usually the result of an abnormal bending to one side or violent twisting, often from a car accident.

A fracture-dislocation is also typically caused by a violent trauma, such as a car accident. This type of injury includes a fracture of the bone, as well as damage to soft tissue nearby and, in many cases, the spinal cord. In addition to a break, the affected vertebra also moves out of its position. This is called dislocation.

Extension

An extension injury refers to the forced, abnormal extension or pulling of bones in the vertebrae.

A Chance fracture is a type of extension fracture that commonly occurs in a car accident. The upper body is jerked forward, while the lower body is kept in place with a seat belt around the waist. This injury may cause damage to ligaments in the back and lead to muscle-related soreness and pain triggered by the fracture.

If there’s damage to any internal organs, you may feel a lot of pain from those injuries. It may actually mask some of the pain emanating from your back.

How is it diagnosed?

Diagnosing a spinal fracture starts with a physical examination and a review of your symptoms. It’s also critical that you share your medical history, including any injuries that may have caused a fracture or conditions, such as osteoporosis, that may have weakened your bones.

A spinal X-ray can easily reveal a fracture. Other imaging tests may be helpful in providing detailed pictures of the bones. One of the more commonly used tests is a CT scan. A CT scan provides 3-D, layered views of inside the body. It can help your doctor diagnose soft-tissue injuries and bleeding problems that X-rays can’t detect.

An MRI can also help your doctor find bleeding issues or injuries to muscles and ligaments.

Your doctor may run neurological tests of your reflexes and your ability to feel and move your limbs to help diagnose any spinal cord or nerve damage.

Treatment options

As with any type of injury, a spinal fracture’s treatment depends on its severity and location. A minor fracture may heal on its own, without surgery.

You may need to wear an external back brace to help stabilize the spine if the injury is in the upper (thoracic) or lower (lumbar) regions of the back.

A fracture of a neck (cervical) vertebra will require a neck brace. If the neck injury requires greater stabilization and little to no movement, a “halo” may be needed. A halo is a sturdy ring worn around the head. It’s kept in place with pins and attached to a vest that’s worn over your torso.

Serious broken back injuries, however, need surgery before bracing. The type of surgery depends on the kind of fracture. In many cases, a surgeon must remove bone fragments. These fragments may threaten the spinal cord and nerve roots.

Here are the standard surgical options for some of the most common fractures:

Compression fracture

Two procedures are usually done if surgery is needed to repair a compressed vertebra. Vertebroplasty is a relatively new procedure that involves a catheter.

The surgeon guides the catheter to the site of the fracture. The catheter then injects a special bone cement into the break. This helps stabilize the bone and relieve some pain, but it doesn’t treat any deformity caused by the injury. You may have a change in posture and some limited range of motion following vertebroplasty.

Kyphoplasty is a similar procedure. It’s performed through a small incision in the back. The surgeon places an inflatable balloon inside the broken bone to create a space where bone cement is then used to build the vertebra back up to its original height.

Burst fracture

For a burst fracture, treatment options include operating from the front of the body to perform a corpectomy. This is the surgical removal of all or part of a vertebra.

After this, the surgeon replaces the missing bone with artificial plates or screws (known as instrumentation). This is done when there’s also compression on one or more vertebrae. It can relieve pressure on those bones and on the spinal cord or nerves that might also be affected.

Spinal fusion performed from the back may treat a burst fracture if injury has caused the spine to bulge outward. Fusion requires instrumentation to join two or more vertebrae into a single bony structure. This helps keep the spine stable and reduces pain. Spinal fusion does reduce the flexibility and range of motion.

Chance fracture

A posterior (backside) spinal fusion is also appropriate in treating Chance fractures when a back brace alone is insufficient.

Fracture-dislocation

The first option is usually a posterior spinal fusion with instrumentation, as well as a realignment of the vertebra. An anterior (front side) corpectomy with or without instrumentation may be appropriate if the spinal fusion and realignment doesn’t correct the problem.

Recovery timeline

If your injuries are limited to a spinal fracture that can be treated with a relatively simple kyphoplasty, you may need to stay in the hospital for one night. More complicated surgeries or treatment of other injuries may need a much longer hospital stay.

Whether or not you have surgery, you’ll usually need a brace for about 8 to 12 weeks. After this, you may need three to six weeks of physical therapy.

Your doctor will advise you when you can resume normal activities. Minor fractures may allow you to return to your usual lifestyle relatively quickly. Major broken back injuries could require months or years of recovery before you can pick up where you left off.

Plan on some back stiffness at first. Some stiffness may remain if you needed spinal fusion.

What’s the outlook?

A broken back injury that includes damage to your spinal cord or nervous system can be a life-altering event. Even minor spinal fractures can affect your ability to engage in certain sports or other activities. However, there’s a wide range of treatments available for all types of fractures.

The most important thing you can do is to follow your doctor’s advice and participate enthusiastically in physical therapy. You may receive exercises and other lifestyle advice to follow once physical therapy ends. But if you do those things and report any symptoms or changes in your condition to your doctor promptly, you may have a healthy recovery and be able to resume most, if not all, your usual activities.