Burst fracture
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]
Overview
A burst fracture is a type of traumatic spinal injury in which a vertebra breaks from a high-energy axial load, with pieces of the vertebra shattering into surrounding tissues and sometimes the spinal canal.[1]
Classification
Burst fractures are categorized by the "severity of the deformity, the severity of (spinal) canal compromise, the degree of loss of vertebral body height, and the degree of neurologic deficit impact the determination of whether these injuries are unstable."
Causes
Burst fractures are most often caused by car accidents or by falls.
Natural History, Complications and Prognosis
In the long-term, varying degrees of pain, function, and appearance may affect the traumatized region during the patient's lifetime. A burst fracture results in a permanent decrease in anterior height, varying degrees of kyphosis,[2] and possible changes in neurological signal intensity with possible deterioration over time.
Diagnosis
Immediate hospitalization is required, as such injuries may result in varying degrees of spinal cord injury with possible paralysis.
X Ray
X-rays and MRIs are taken to determine whether the burst fracture can be managed with or without surgery.
Treatment
Surgery
Surgical management is required when the burst fracture is unstable. Different surgical treatments are available, the most common involving fusion of the remaining vertebra in the traumatized area, and removal of the larger loose vertebra pieces. A "spinal fusion" surgery entails two or more vertebra being permanently immobilized through surgery using titanium implants. Another less common technique is to replace the burst vertebra with an artificial one.[3] This latter strategy has been used successfully in elderly patients, and has not yet been attempted in younger patients due to the unknown stability over the long-term.
Nonsurgical management is possible when the burst fracture patient is intact neurologically. Nonsurgical treatment involves the use of a full-body, exterior brace, normally a Thoracic Lumbar Sacral Orthosis (TLSO), often custom-molded to the patient's body. X-rays and MRIs are again taken with the patient every 3 weeks in the TLSO to determine whether the spine will remain stable. The TLSO is worn for 2 months 24/7. The patient undergoes several months of physical therapy to strengthen atrophied muscles and basically learn how to walk again. It is probable that the patient may exhibit some spinal dislocation after removal of the TLSO, and it is well within expected parameters with little neurological impact experienced by month 3. If no further major dislocation or subluxation occurs, no other external stabilization may be required.