A spinal fracture, also called a vertebral fracture or a broken back, is a fracture affecting the vertebrae of the spinal column. Most types of spinal fracture confer a significant risk of spinal cord injury. After the immediate trauma, there is a risk of spinal cord injury (or worsening of an already injured spine) if the fracture is unstable, that is, likely to change alignment without internal or external fixation.
|Synonyms||Vertebral fracture, broken back|
|Lateral spine X-ray showing osteoporotic wedge fractures of L1/2|
- Cervical fracture
- Clay-shoveler fracture – fracture through the spinous process of a vertebra occurring at any of the lower cervical or upper thoracic vertebrae
- Burst fracture – in which a vertebra breaks from a high-energy axial load
- Compression fracture – a collapse of a vertebra, often resulting in the form of a wedge-shape due to larger compression anteriorly
- Chance fracture – compression injury to the anterior portion of a vertebral body with concomitant distraction injury to posterior elements
- Holdsworth fracture – an unstable fracture dislocation of the thoracolumbar junction of the spine
- Distraction is an where there is pulling apart of the vertebrae. Distraction injuries generally cause breaks in osseous and ligamentous supporting structures, and are therefore generally unstable. A distraction injury on the posterior side of a vertebra can lead to a compression fracture on its anterior side.
Risk of spinal cord injuryEdit
Thoracolumbar injury classification and severity scoreEdit
The thoracolumbar injury classification and severity score (TLICS) is a scoring system to determine the need to surgically treat a spinal fracture of thoracic or lumbar vertebrae. The score is the sum of three values, each being the score of the most fitting alternative in three categories:
- Compression fracture - 1 point
- Burst fracture - 2 points
- Translational rotational injury - 3 points
- Distraction injury - 4 points
Posterior ligamentous complex
- Intact - 0 points
- Suspected injury or indeterminate - 2 points
- Injured - 3 points
- Intact - 0 points
- Spinal nerve root injury - 2 points
- Incomplete injury of cord/conus medullaris - 3 points
- Complete injury of cord/conus medullaris (complete) - 2 points
- Cauda equina syndrome - 3 points
A TLICS score of less than 4 indicates non-operative treatment, a score of 4 indicates that the injury may be treated operatively or non-operatively, while a score of more than 4 means that the injury is usually considered for operative management.
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