Spinal Fracture (Broken Back or Neck)

First aid for a suspected spinal injury

1. Call 911 or your local emergency number.
2. Keep the person still. Do not move them unless they are in immediate danger, such as fire or traffic.
3. Hold the head and neck in line with the body, without pulling.
4. Do not remove a helmet unless it is blocking breathing.
5. If they vomit or must be moved, roll the head, neck and body together as one unit (log-roll) with several people if possible.
6. Check breathing and be ready to start CPR if they stop breathing.

How the spine is built

The spine has 7 cervical (neck), 12 thoracic (mid-back) and 5 lumbar (lower back) vertebrae, plus the sacrum and coccyx. The spinal cord runs through a canal in the vertebrae down to about the first lumbar vertebra, below which nerve roots (the cauda equina) continue. The junction between the thoracic and lumbar spine (T11 to L2) is the most common site of traumatic fractures.

Types of spinal fracture

Causes

• High-energy trauma: motor vehicle crashes, falls from height, sports (diving, horse riding, skiing), violence.
• Osteoporosis: weak bones can fracture from minimal force. Many vertebral fractures in older adults happen without a fall and go unnoticed.
• Cancer in the bone: metastases from breast, lung, prostate, kidney or thyroid cancer, or multiple myeloma, can weaken vertebrae (pathological fracture).
• Long-term steroid use, which thins bone.
• Ankylosing spondylitis, which makes the spine stiff and brittle.

Symptoms

• sudden back or neck pain, worse with standing, walking or movement
• tenderness over the spine
• muscle spasm
• with nerve or cord involvement: numbness, tingling, weakness, paralysis, or bladder and bowel problems
• with osteoporotic fractures: sudden mid-back pain, or gradual loss of height and a curved upper back (kyphosis), sometimes with no pain at all

Diagnosis

• Examination: spine tenderness, strength, sensation and reflexes.
• X-rays: show many fractures and alignment.
• CT scan: the main test after significant trauma; shows bone detail.
• MRI: shows the spinal cord, nerves, ligaments and whether a compression fracture is new; helps distinguish osteoporotic from cancer-related fractures.
• Bone density scan (DEXA) after an osteoporotic fracture.
• Blood tests if cancer or myeloma is suspected.

Treatment

Stable fractures

• pain relief: acetaminophen (paracetamol), NSAIDs if appropriate, short-term stronger medicines
• bracing for 6 to 12 weeks for some fractures
• gradual return to activity: walking is encouraged; prolonged bed rest weakens bones and muscles
• physical therapy for posture, core strength and balance

Osteoporotic compression fractures

• pain control, short-term activity changes and sometimes a brace
• vertebral augmentation (vertebroplasty or kyphoplasty): bone cement injected into the vertebra may help selected patients with severe, persistent pain, though evidence is mixed
• treat the osteoporosis: calcium, vitamin D, and bone-strengthening medicines such as bisphosphonates or other agents to prevent further fractures

Unstable fractures or nerve injury

• surgery to decompress the spinal cord or nerves and stabilize the spine with rods and screws (spinal fusion)
• rehabilitation for spinal cord injury

Recovery

• Most stable fractures heal in about 8 to 12 weeks, with pain improving in the first few weeks.
• After surgery, recovery can take several months, and longer with nerve injury.
• Some people have chronic back pain, posture changes or reduced height.
• A first osteoporotic vertebral fracture greatly increases the risk of more fractures, so prevention is essential.

Prevention

• wear seatbelts and use helmets for cycling, riding and contact sports
• never dive head-first in shallow or unknown water
• prevent falls: remove trip hazards, improve lighting, strength and balance exercises
• maintain bone health: calcium, vitamin D, weight-bearing exercise, no smoking, limit alcohol
• get bone density testing as recommended, especially women 65 and over

Frequently asked questions

What are the symptoms of a spinal fracture?

Common symptoms are sudden back or neck pain that worsens with movement and tenderness over the spine. If nerves are affected, there may be numbness, tingling, weakness or bladder and bowel problems. Osteoporotic fractures can be painless and cause only height loss.

How long does a spinal fracture take to heal?

Most stable spinal fractures heal in about 8 to 12 weeks. Pain usually improves within the first few weeks. Fractures needing surgery or involving nerve damage may take months, with rehabilitation.

Can you walk with a fractured spine?

Many people with stable fractures, especially osteoporotic compression fractures, can walk and are encouraged to stay active. After a significant injury, however, do not move until a spine injury has been ruled out, because movement can damage the spinal cord.

What is a compression fracture of the spine?

A compression fracture is when the front of a vertebra collapses into a wedge shape, usually because bones are weakened by osteoporosis. It can happen from a minor fall, lifting or coughing and may cause sudden back pain or gradual height loss.

Do spinal fractures need surgery?

Most do not. Stable fractures are treated with pain relief, bracing and physical therapy. Surgery is needed for unstable fractures, fractures pressing on the spinal cord or nerves, and some cases of severe deformity.