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A spinal fracture, also called a vertebral fracture or a broken back, is a fracture affecting the
vertebrae The spinal column, a defining synapomorphy shared by nearly all vertebrates, Hagfish are believed to have secondarily lost their spinal column is a moderately flexible series of vertebrae (singular vertebra), each constituting a characteristi ...
of the spinal column. Most types of spinal fracture confer a significant risk of
spinal cord injury A spinal cord injury (SCI) is damage to the spinal cord that causes temporary or permanent changes in its function. Symptoms may include loss of muscle function, sensation, or autonomic function in the parts of the body served by the spinal cor ...
. 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 Internal may refer to: *Internality as a concept in behavioural economics *Neijia, internal styles of Chinese martial arts *Neigong or "internal skills", a type of exercise in meditation associated with Daoism *''Internal (album)'' by Safia, 2016 ...
or
external fixation External fixation is a surgical treatment wherein rods are screwed into bone and exit the body to be attached to a stabilizing structure on the outside of the body. It is an alternative to internal fixation, where the components used to provide ...
.


Types

*
Cervical fracture A cervical fracture, commonly called a broken neck, is a fracture of any of the seven cervical vertebrae in the neck. Examples of common causes in humans are traffic collisions and diving into shallow water. Abnormal movement of neck bones or pie ...
**Fracture of '' C1'', including Jefferson fracture **Fracture of '' C2'', including Hangman's fracture **
Flexion teardrop fracture A flexion teardrop fracture is a fracture of the anteroinferior aspect of a cervical vertebral body due to flexion of the spine along with vertical axial compression. The fracture continues sagittally through the vertebral body, and is associated w ...
– a fracture of the anteroinferior aspect of a
cervical vertebra In tetrapods, cervical vertebrae (singular: vertebra) are the vertebrae of the neck, immediately below the skull. Truncal vertebrae (divided into thoracic and lumbar vertebrae in mammals) lie caudal (toward the tail) of cervical vertebrae. In sa ...
*
Clay-shoveler fracture Clay-shoveler's fracture is a stable fracture through the spinous process of a vertebra occurring at any of the lower cervical or upper thoracic vertebrae, classically at C6 or C7. In Australia in the 1930s, men digging deep ditches tossed clay ...
– fracture through the
spinous process The spinal column, a defining synapomorphy shared by nearly all vertebrates, Hagfish are believed to have secondarily lost their spinal column is a moderately flexible series of vertebrae (singular vertebra), each constituting a characteristic ...
of a
vertebra The spinal column, a defining synapomorphy shared by nearly all vertebrates, Hagfish are believed to have secondarily lost their spinal column is a moderately flexible series of vertebrae (singular vertebra), each constituting a characteristi ...
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 In medicine the Holdsworth fracture is an unstable fracture dislocation of the thoraco lumbar junction of the spine. The injury comprises a fracture through a vertebral body, rupture of the posterior spinal ligaments and fractures of the facet j ...
– an unstable fracture
dislocation In materials science, a dislocation or Taylor's dislocation is a linear crystallographic defect or irregularity within a crystal structure that contains an abrupt change in the arrangement of atoms. The movement of dislocations allow atoms to s ...
of the thoraco lumbar junction of the spine *''Distraction'' is where there is a 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.


Cervical fracture

A
medical history The medical history, case history, or anamnesis (from Greek: ἀνά, ''aná'', "open", and μνήσις, ''mnesis'', "memory") of a patient is information gained by a physician by asking specific questions, either to the patient or to other peo ...
and
physical examination In a physical examination, medical examination, or clinical examination, a medical practitioner examines a patient for any possible medical signs or symptoms of a medical condition. It generally consists of a series of questions about the pati ...
can be sufficient in
clearing the cervical spine Clearing the cervical spine is the process by which medical professionals determine whether cervical spine injuries exist, mainly regarding cervical fracture. It is generally performed in cases of major trauma. This process can take place in the ...
. Notable
clinical prediction rule A clinical prediction rule or clinical probability assessment specifies how to use medical signs, symptoms, and other findings to estimate the probability of a specific disease or clinical outcome. Physicians have difficulty in estimated risks of ...
s to determine which patients need medical imaging are Canadian C-spine rule and the National Emergency X-Radiography Utilization Study (NEXUS). The AO Foundation has developed a descriptive system for cervical fractures, the ''AOSpine subaxial cervical spine fracture classification system''. The indication to surgically stabilize a cervical fracture can be estimated from the ''Subaxial Injury Classification'' (SLIC).Page 94
an
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in:


Thoracolumbar fracture

Vertebral fractures of the
thoracic vertebrae In vertebrates, thoracic vertebrae compose the middle segment of the vertebral column, between the cervical vertebrae and the lumbar vertebrae. In humans, there are twelve thoracic vertebrae and they are intermediate in size between the cervical ...
,
lumbar vertebrae The lumbar vertebrae are, in human anatomy, the five vertebrae between the rib cage and the pelvis. They are the largest segments of the vertebral column and are characterized by the absence of the foramen transversarium within the transverse p ...
or sacrum are usually associated with major trauma and can cause
spinal cord injury A spinal cord injury (SCI) is damage to the spinal cord that causes temporary or permanent changes in its function. Symptoms may include loss of muscle function, sensation, or autonomic function in the parts of the body served by the spinal cor ...
that results in a neurological deficit.


Thoracolumbar injury classification and severity score

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: Updated: Dec 09, 2014 Injury type *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 Neurology *Intact - 0 points *
Spinal nerve root Spinal nerve root may refer to: * Posterior root of spinal nerve * Anterior root of spinal nerve In anatomy and neurology, the ventral root of spinal nerve, anterior root, or motor root is the efferent motor root of a spinal nerve. At its dist ...
injury - 2 points *Incomplete injury of cord/
conus medullaris ''Conus'' is a genus of predatory sea snails, or cone snails, marine gastropod mollusks in the family Conidae.Bouchet, P.; Gofas, S. (2015). Conus Linnaeus, 1758. In: MolluscaBase (2015). Accessed through: World Register of Marine Species ...
- 3 points *Complete injury of cord/conus medullaris (complete) - 2 points *
Cauda equina syndrome Cauda equina syndrome (CES) is a condition that occurs when the bundle of nerves below the end of the spinal cord known as the cauda equina is damaged. Signs and symptoms include low back pain, pain that radiates down the leg, numbness around ...
- 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.


AOSpine Thoracolumbar Injury Classification System

AOSpine Thoracolumbar Injury Classification System (ATLICS) is the most recent classification scheme for thoracolumbar injuries.Abedi, Aidin; Mokkink, Lidwine B; Zadegan, Shayan A; Paholpak, Permsak; Tamai, Koji; Wang, Jeffrey C; Buser, Zorica (October 2018). "Reliability and Validity of the AOSpine Thoracolumbar Injury Classification System: A Systematic Review." ''Global Spine Journal''. 2192568218806847. doi: 10.1177/2192568218806847. ATLICS is broadly based on the TLICS system and has sufficient reliability irrespective of the experience of the observer. ATLICS is primarily focused on fracture morphology, and has two additional sections addressing the neurological grading and clinical modifiers:


Fracture morphology

* Type A: Compression injuries (sub-types A0-A4) * Type B: Distraction injuries (sub-types B1-B3) * Type C: Translation injuries


Neurological status

* N0: neurologically intact * N1: transient deficit * N2: radiculopathy * N3: "incomplete spinal cord injury or cauda equina injury" * N4: "complete spinal cord injury" * NX: unknown neurological status


Modifiers

* M1: unknown tension band injury status * M2: comorbidities


Osteoporotic vertebral compression fracture

Osteoporosis is a condition causing weakening of the bone due to loss of bone substance. Women are about four times more likely to be affected by osteoporosis than men. Osteoporosis may occur after the menopause or as a result of malnutrition, hyperthyroidism, alcoholism, kidney disease. Osteoporosis may occur after treatment with antiepileptic drugs, proton pump inhibitors, antidepressants, corticosteroids or chemotherapy. Osteoporotic vertebral body compression fractures might occur even after minor trauma or while twisting, bending or coughing.


Sacral fracture


References


External links

{{Medical resources , ICD10 = {{ICD10, S, 32, 0, s, 30-{{ICD10, S, 32, 1, s, 30 , ICD9 = {{ICD9, 805 , ICDO = , OMIM = , MedlinePlus = , eMedicineSubj = article , eMedicineTopic = 248236 , MeshID = D016103 Spinal cord disorders