Lumbar Spine Fracture

Overview

The lumbar spine is made up of five large vertebrae in the lower back that carry much of the body's weight and allow bending and twisting. A lumbar spine fracture is a break in one or more of these bones. It can range from a small, stable crack to a severe break that affects the stability of the spine or the spinal nerves.

These fractures may follow a forceful injury such as a fall or car crash, or they may occur in weakened bone with little force, as in osteoporosis. While many heal with supportive care, some are unstable or threaten the nerves and require urgent treatment, so any suspected lumbar fracture should be evaluated promptly.

Symptoms

The most common symptom is sudden, severe pain in the lower back that worsens with movement and eases with rest. Depending on the fracture, you may also notice:

• Tenderness and swelling over the lower spine
• Pain that radiates into the buttocks or legs
• Numbness, tingling, or weakness in the legs
• Difficulty standing or walking
• In severe cases, loss of bladder or bowel control

Leg weakness, numbness in the groin or inner thighs, or loss of bladder or bowel control can mean the spinal nerves are being compressed. These are emergencies and require immediate care.

Causes

Lumbar fractures occur when force exceeds what the bone can withstand, or when the bone itself is weak. Common causes include:

• High-energy trauma: Car crashes, falls from a height, or sports injuries.
• Osteoporosis: Thinned, fragile bone can collapse with minor strain, coughing, or a low fall, causing a compression fracture.
• Disease that weakens bone: Cancer that has spread to the spine or infection can make vertebrae break more easily.

The type of fracture, such as a stable compression fracture or a more serious burst or fracture-dislocation, depends on how the force was applied and the strength of the bone.

Risk Factors

• Osteoporosis or low bone density
• Older age
• High-impact activities or occupations
• Previous spinal fracture
• Long-term steroid use
• Cancer affecting bone or certain bone diseases
• Poor balance and frequent falls

Diagnosis

Diagnosis combines an examination of strength, sensation, and reflexes with imaging:

• X-rays: Show the bones and can reveal many fractures.
• CT scan: Gives detailed views of the fracture pattern and any bone pushed toward the spinal canal.
• MRI: Used when nerve or spinal cord involvement, soft-tissue injury, or tumor is a concern.
• Bone density testing: Considered when osteoporosis may have contributed.

A careful neurological exam helps determine whether the fracture is affecting nerves and how urgently treatment is needed.

Treatment

Treatment depends on the fracture's stability and whether nerves are involved.

• Conservative care: Stable fractures often heal with rest, pain control, and a back brace, followed by gradual activity.
• Bone-strengthening treatment: For osteoporotic fractures, medicines and supplements help reduce future breaks.
• Minimally invasive procedures: In some painful compression fractures, bone cement may be injected to stabilize the vertebra.
• Surgery: Unstable fractures or those compressing nerves may need surgery to relieve pressure and fix the spine with hardware.
• Rehabilitation: Physical therapy restores strength, posture, and mobility.

Many stable fractures heal over several weeks to a few months, while more severe injuries take longer.

Prevention

• Keep bones strong with calcium, vitamin D, and weight-bearing exercise
• Get screened and treated for osteoporosis if you are at risk
• Reduce fall hazards at home and improve lighting
• Use seatbelts and proper safety gear during sports and work
• Work on balance and core strength

When to See a Doctor

Seek immediate medical care after any significant fall or accident if you have severe back pain, especially if you cannot move comfortably. Call emergency services right away for:

• Numbness, tingling, or weakness in the legs
• Numbness around the groin, buttocks, or inner thighs
• Loss of bladder or bowel control
• Back pain after major trauma in someone who may have other injuries

Do not move a person with a suspected serious spine injury unless they are in danger; wait for trained help. These symptoms can signal nerve compression that needs urgent treatment to prevent lasting damage.

Related Topics

Frequently Asked Questions

References

1. American Academy of Orthopaedic Surgeons (AAOS). Fractures of the Thoracic and Lumbar Spine.
2. Mayo Clinic. Spinal fractures and osteoporosis.
3. MedlinePlus, U.S. National Library of Medicine. Spinal fractures.
4. National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS). Osteoporosis.