Spinal Fractures
They are high-energy injuries that occur after traffic accidents or falling from a height, especially in young active individuals. Most of the spinal fractures (70%) are seen in the thoracic and lumbar vertebrae, most commonly in the 12th thoracic and 1st lumbar vertebrae. It is most common between the ages of 18-50 and is 4 times more common in men.Depending on the severity of the injury, the fracture may appear as a collapse, explosion, or dislocation with the fracture. The greater the severity of the injury, the greater the risk of spinal cord injury. Pain and muscle spasm occur due to the fracture. The spinal cord itself or the nerve roots emerging from the spinal cord may be injured during this time. In such a case, problems ranging from a simple loss of feeling that may occur in the arms or legs to urinary incontinence and paralysis may occur. In the first examinations after the injury, important findings about the presence and degree of spinal cord damage are obtained. If the fracture is not recognized in the early period or treated appropriately, it may present with a hunchback or scoliosis in the future.
A treatment plan is drawn up after the patient's x-ray, tomography, and MRI examinations. The aim is to bring the patient to their pre-fracture quality of life. Corset or plaster cast treatment can be applied in patients who are formed in a single region of the spine, do not have excessive collapse or fragmentation in the bone, and have not developed spinal cord or nerve damage. Corset treatment may take up to 3 months depending on the type of fracture. On the other hand, surgical treatment is applied in cases with fracture-dislocation, excessive fragmentation and collapse type fracture, and spinal cord nerve damage. The spine is fixed by means of a number of metal-like materials such as screws, rods, and cages. These surgical interventions are performed from the posterior (back or lower back) approach or from two separate surgical incisions to be made both from the back and the front, depending on the degree of fragmentation-collapse and the degree of narrowing that occurs after the fracture in the spinal cord canal. In patients with partial spinal cord injury, complete or partial recovery is possible thanks to the physical therapy program to be applied after surgical treatment.
In our country, where the average life expectancy is increasing, another cause of spinal fractures in advanced ages is compression fractures due to osteoporosis. These fractures can occur during walking without any fall or injury, or they are low-energy traumas that occur frequently after falls in the home. Osteoporotic fractures are mostly collapse type fractures and since it is a low-energy injury, spinal cord injury is usually not in question. These fractures can often be treated with conservative methods such as medication, corset use, and bed rest. For this reason, these methods should be chosen in the first place. However, in a group of patients, the pain persists despite all efforts, hindering the patients' daily activities and reducing their quality of life. In these patients, the bone cementing procedure (vertebroplasty) to be applied to the broken spinal bone can be applied as an alternative. If the balloon is inflated in the vertebrae before cementing, the fracture is corrected and the cement is applied after that, this process is called kyphoplasty. These methods consist of the injection of cement into the broken bone, which is applied through a set of wire and pipe systems through a 1 cm incision to the patient lying face down under regional anesthesia. Success rate and patient satisfaction are quite high in correctly selected patients. Another closed surgical method is stent treatment. In the spine fractured with local or general anesthesia, the area that collapsed through a 1 cm incision is raised again and a cage is placed inside and the spine is tried to be restored to its former form