Fracture of the Vertebra (Broken Back or Neck)

First aid for a suspected spinal injury

After a significant fall, crash or diving accident:

1. Do not move the person unless they are in immediate danger (fire, traffic, drowning).
2. Call 911.
3. Keep the head, neck and back still and in line. Kneel behind the head and hold it gently in position.
4. Do not remove a helmet unless needed to open the airway.
5. If they vomit or must be moved, roll them as a unit ("log roll") with helpers, keeping the spine straight.

Types of vertebral fracture

The thoracolumbar junction (where the mid back meets the low back) is the most common site of traumatic fractures.

Causes and risk factors

Trauma

• car and motorcycle crashes
• falls from height or ladders
• diving into shallow water
• sports such as football, horse riding and skiing
• violence

Weakened bone

• osteoporosis: the most common cause overall. Vertebral fractures are the most common osteoporotic fracture; many happen without a fall
• long-term corticosteroid use
• cancer spreading to the spine (bone metastases) or multiple myeloma
• bone infection

Symptoms

• sudden back or neck pain, often sharp, worse with standing, walking and bending, and eased by lying down
• tenderness over the spine
• muscle spasm
• loss of height or a hunched posture (kyphosis) after one or more compression fractures
• numbness, tingling or weakness in the arms or legs if nerves or the cord are compressed
• bladder or bowel problems with severe nerve compression

About two thirds of osteoporotic vertebral fractures cause few symptoms and are found by chance on X-rays.

Diagnosis

• examination: spinal tenderness, nerve function in the arms and legs, reflexes
• X-rays: show most fractures and alignment
• CT scan: shows the bone in detail and whether fragments enter the spinal canal; standard after major trauma
• MRI: shows spinal cord and ligament injury and whether a compression fracture is new or old
• bone density (DXA) scan after an osteoporotic fracture
• blood tests if cancer or myeloma is suspected

Treatment

Stable fractures

• pain relief: acetaminophen (paracetamol), NSAIDs if safe, and short-term stronger medicines; calcitonin is sometimes used for acute osteoporotic fracture pain
• activity: short rest followed by early walking; prolonged bed rest weakens bones and muscles
• bracing: a back brace may be used for comfort and support for 6 to 12 weeks
• physical therapy: posture, core strength and safe movement

Osteoporotic compression fractures

Beyond pain control, treating the osteoporosis is essential, because one vertebral fracture greatly raises the risk of another: bisphosphonates, denosumab, teriparatide, abaloparatide or romosozumab, plus calcium, vitamin D, exercise and fall prevention.

Vertebroplasty or kyphoplasty (injecting bone cement into the fracture) is considered for selected patients with severe pain that does not improve with conservative care. Evidence on benefit is mixed.

Unstable fractures or nerve injury

• surgery with screws and rods to stabilize the spine (spinal fusion), and to remove bone pressing on the spinal cord or nerves
• urgent surgery for progressive neurological deficits or cauda equina syndrome
• rehabilitation for spinal cord injury

Recovery

• stable compression fractures: pain usually improves over 6 to 12 weeks
• traumatic fractures: bone healing takes about 3 months; full recovery can take longer
• after surgery: several months of rehabilitation
• spinal cord injuries: recovery varies greatly and may be incomplete

Prevention

• wear seat belts and use proper car seats
• never dive headfirst into shallow or unknown water
• use safe ladder practices and fall-proof the home for older adults
• screen for and treat osteoporosis, especially in women over 65 and anyone with risk factors

Frequently asked questions

What are the symptoms of a fractured vertebra?

Symptoms include sudden back or neck pain that worsens with movement and eases when lying down, tenderness over the spine, and loss of height. Numbness, tingling, weakness or bladder problems suggest nerve or spinal cord involvement and need emergency care.

How long does a vertebral fracture take to heal?

Most stable fractures heal in about 3 months, with pain improving over 6 to 12 weeks. Osteoporotic compression fractures may cause lingering pain. Fractures needing surgery and those with spinal cord injury take longer to recover.

Can you walk with a fractured vertebra?

Many people with stable compression fractures can and should walk, with pain relief and sometimes a brace. After trauma, however, someone with suspected spinal injury should not move until assessed, because an unstable fracture can damage the spinal cord.

What causes a compression fracture in the spine?

The most common cause is osteoporosis, which weakens vertebrae so they collapse with minor force like bending, lifting or coughing. Trauma, cancer spreading to the spine and long-term steroid use are other causes.

Does a broken vertebra always need surgery?

No. Most vertebral fractures, especially stable compression fractures, are treated without surgery using pain relief, activity modification and sometimes a brace. Surgery is needed for unstable fractures, fractures that compress the spinal cord or nerves, or severe deformity.