Lumbar Spine Fracture (Broken Lower Back)

First steps after a suspected lumbar fracture

• High-energy injury (fall from height, car or motorcycle crash, sports collision): keep the person still and lying as found, call 911, and wait for paramedics. Only move them to escape immediate danger, keeping the head, neck and back in line.
• Minor fall in an older adult with sudden severe back pain but normal leg strength and bladder control: get same-day medical assessment.

Lumbar spine anatomy and why level matters

The lumbar spine carries most of the body's weight. Its vertebrae are the largest in the spine. The spinal cord usually ends at about L1 to L2. Below that, the spinal canal holds the cauda equina, a bundle of nerve roots that control the legs, bladder, bowel and sexual function.

• L1 and the thoracolumbar junction (T11 to L2): the most commonly fractured area, where the stiff upper spine meets the mobile lower back. Injuries here can affect the end of the spinal cord (conus medullaris) or the cauda equina.
• L2 to L5: less often fractured in trauma. Nerve damage involves nerve roots, which generally recover better than the spinal cord itself.
• L5: a common site of stress fractures in the pars (a small bridge of bone) in young athletes, called spondylolysis.

Types of lumbar spine fracture

A compression fracture is the most common type, because of osteoporosis. For an overview of fractures anywhere in the spine, see spinal fracture.

Symptoms

• sudden, sharp low back pain that is worse when standing, walking, bending or twisting and eases lying down
• tenderness over the spine
• muscle spasm
• pain spreading around the waist or into the hips
• loss of height or a forward stoop after several compression fractures

Signs of nerve involvement:

• leg weakness, numbness or tingling
• numbness in the saddle area
• difficulty passing urine, incontinence or constipation
• erectile dysfunction

These suggest compression of the cauda equina or conus. Cauda equina syndrome is a surgical emergency.

Some osteoporotic compression fractures cause only mild pain or none and are found on X-rays done for other reasons.

Causes and risk factors

• Trauma: falls from height, road traffic crashes, sports injuries and assaults. Young men are most affected.
• Osteoporosis: the most common cause in people over 50, especially women after menopause. Even sneezing, lifting a grocery bag or stepping off a curb can cause a fracture.
• Long-term steroid use, smoking, heavy alcohol use and low body weight, all of which weaken bone.
• Cancer: spread to the spine from breast, prostate, lung, kidney or thyroid cancer, or multiple myeloma.
• Infection of the spine, which weakens bone.

How it is diagnosed

1. Exam: tenderness, strength, sensation, reflexes, and sometimes a rectal exam to check nerve function.
2. X-rays: show most compression fractures and alignment.
3. CT scan: the main test after significant trauma. It shows the fracture pattern and bone fragments in the canal.
4. MRI: shows damage to nerves, discs and ligaments, and whether a compression fracture is new or old. It helps decide stability.
5. Bone density (DEXA) scan and blood tests: after a low-energy fracture, to diagnose osteoporosis and look for cancer or other causes.

Treatment

Stable fractures without nerve damage

• Pain relief: acetaminophen (paracetamol), NSAIDs if safe for you, and short courses of stronger medicines. Follow the label dose for over-the-counter medicines.
• A brace: a rigid back brace (TLSO) may be used for 6 to 12 weeks to limit bending, although many stable fractures heal without one.
• Early walking: encouraged within days. Bed rest is avoided because it weakens bones and muscles and raises the risk of blood clots and pneumonia.
• Follow-up X-rays to make sure the vertebra is not collapsing further.

Osteoporotic compression fractures

Pain relief, activity and osteoporosis treatment to prevent further fractures. Vertebroplasty or kyphoplasty, which inject bone cement into the vertebra, may be considered for severe pain that does not improve after a few weeks.

Unstable fractures and nerve damage

Surgery decompresses the nerves and stabilizes the spine, usually with screws and rods. It is done urgently when there is nerve compression.

Recovery time

• Stable compression and transverse process fractures: pain usually eases noticeably within 4 to 6 weeks, and bone heals in about 8 to 12 weeks.
• Burst fractures without surgery: about 3 months in a brace, then physical therapy.
• After surgery: walking within days, desk work often in 4 to 6 weeks, heavy work and sports in 3 to 6 months or longer.
• Nerve damage: recovery can continue for 1 to 2 years.

Physical therapy builds back and core strength. Some people have long-term back pain, especially after severe fractures.

Preventing lumbar fractures

• Treat osteoporosis with medication, calcium, vitamin D and weight-bearing exercise.
• Prevent falls at home: good lighting, no loose rugs, grab bars, and footwear with grip.
• Wear a seat belt correctly, with the lap belt low across the hips.
• Use proper technique and graded training in sports that load the lower back.

Frequently asked questions

Can you walk with a lumbar spine fracture?

Often yes. Many people with stable compression or transverse process fractures can walk, although it is painful. Being able to walk does not rule out a fracture or instability. Anyone with back pain after significant trauma should be kept still until they are assessed.

How long does a lumbar fracture take to heal?

Most stable lumbar fractures heal in about 8 to 12 weeks, with pain improving after 4 to 6 weeks. Burst fractures and fractures treated with surgery can take 3 to 6 months to recover from, and nerve injuries may take up to 2 years to improve.

What is an L1 compression fracture?

It is a collapse of the front part of the first lumbar vertebra, the most commonly fractured level in the lower back. It is often caused by osteoporosis or a fall onto the buttocks. Most are stable and treated with pain relief, activity and sometimes a brace.

Do lumbar fractures need surgery?

Most do not. Surgery is needed when a fracture is unstable, when bone fragments compress nerves, or when the spine is badly misaligned. Stable fractures are treated with pain relief, early walking and sometimes a brace. Cement procedures may help painful osteoporotic fractures.

Is a transverse process fracture serious?

The fracture itself is usually minor and stable, and it heals with pain relief and activity. It matters because it signals a hard blow to the side of the body, so doctors check for injuries to the kidneys, spleen, liver and other parts of the spine.