What is spinal fracture?
A spinal fracture is a break in one of the vertebrae of the spine. The two most common patterns are osteoporotic compression fractures (small collapses of a vertebra in patients with weakened bone) and traumatic fractures from falls, motor vehicle accidents, or sports injuries. Treatment depends on the fracture pattern, the patient's neurologic status, the stability of the fracture, and the patient's overall health.
Anatomy
The vertebrae of the spine are arranged in three columns (anterior, middle, posterior). Stable fractures involve only one column and the spine remains aligned; unstable fractures involve two or three columns and can shift, putting the spinal cord or nerve roots at risk. The pattern of the fracture (compression, burst, chance/flexion-distraction, or fracture-dislocation) directs treatment.
Types
Osteoporotic compression fracture
Small collapse of a vertebra in patients with weakened bone. Often occurs with minimal trauma: bending, lifting, even a sneeze.
Traumatic compression or burst fracture
From higher-energy events. Burst fractures can push bone fragments into the spinal canal.
Chance / flexion-distraction fracture
Caused by sudden flexion (classic mechanism: lap-belt injury). Often unstable.
Pathologic fracture
A bone weakened by tumor or infection breaks under normal load.
What are the symptoms of spinal fracture?
- Sudden, severe back or neck pain after a fall or impact
- Pain worsened by movement, often relieved by lying still
- Visible deformity or sudden loss of height (with osteoporotic fractures)
- Numbness, weakness, or paralysis (in severe injuries)
- Bowel or bladder dysfunction (a medical emergency)
What causes spinal fracture?
- Osteoporosis (most common cause in older adults)
- High-energy trauma: falls, motor vehicle accidents, sports
- Tumors or infections weakening the bone (pathologic fracture)
Who is at risk?
- Age over 65
- Female sex (postmenopausal osteoporosis)
- Chronic steroid use
- Low body weight, smoking, heavy alcohol use
- Prior fragility fracture
- High-risk sports or occupations for traumatic fractures
How is spinal fracture diagnosed?
Imaging starts with X-rays, with CT used to characterize bony detail and MRI used to assess soft tissue, ligamentous injury, and any compression of the spinal cord or nerves. Bone density (DXA) testing should follow any osteoporotic fracture to guide future fracture-prevention treatment.
When to see a spine surgeon
Any sudden severe back pain after trauma, or new neurologic symptoms (weakness, numbness, loss of bowel or bladder control) warrants emergency evaluation.
How is spinal fracture treated without surgery?
Stable, neurologically-intact fractures are often treated with bracing, pain control, and a structured rehabilitation program; most osteoporotic compression fractures heal with this approach. Painful osteoporotic fractures that don't respond to conservative care may benefit from kyphoplasty, a minimally invasive procedure that stabilizes the collapsed vertebra with cement and can restore lost height.
When is surgery needed?
Unstable fractures, fractures with neurologic compromise, or those at risk of progressive deformity require surgical stabilization, most often performed using minimally invasive instrumentation to reduce blood loss and accelerate recovery. When the spinal cord or nerves are compressed, decompression is performed at the same time.
Common questions
How serious is a spinal fracture?
It ranges widely. Osteoporotic compression fractures are often stable and heal with conservative care, while unstable traumatic fractures can threaten the spinal cord and require urgent surgical stabilization. Any new weakness, numbness, or loss of bowel or bladder control after an injury is an emergency.
Do vertebral compression fractures heal on their own?
Most osteoporotic compression fractures heal with bracing, pain control, and a structured rehabilitation program. Painful fractures that do not respond may benefit from kyphoplasty, a minimally invasive procedure that stabilizes the collapsed vertebra with cement and can restore lost height.
When does a spinal fracture need surgery?
Unstable fractures, fractures compressing the spinal cord or nerves, and those at risk of progressive deformity require surgical stabilization, most often with minimally invasive instrumentation. Decompression is performed at the same time when neural elements are compressed.
What should happen after an osteoporotic fracture heals?
Bone density (DXA) testing should follow any osteoporotic fracture to guide treatment that reduces the risk of the next one.
Related procedures
Related conditions
Endoscopic treatment options
Many patients with spinal fracture can be treated through incisions of about 7 to 10 mm using endoscopic spine surgery. Dr. Kazarian performs the two-portal endoscopic technique, and explains how it compares with uniportal endoscopy. Whether an endoscopic approach fits your case depends on your imaging and symptoms; see the candidacy guide.
This page is for general educational purposes and is not medical advice. Diagnosis and treatment recommendations require an in-person evaluation. To schedule a consultation with Erick R. Kazarian, MD, please book an appointment.