Back Bone Fracture Treatment

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A spinal fracture, also called a vertebral fracture or a broken back, is a fracture affecting the vertebrae of the spinal column. Most types of spinal fracture confer a significant risk of spinal cord injury. 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 or external fixation.


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Types

  • Cervical fracture
    • Fracture of C1, including Jefferson fracture
    • Fracture of C2, including Hangman's fracture
    • Flexion teardrop fracture - a fracture of the anteroinferior aspect of a cervical vertebra
  • Clay-shoveler fracture - fracture through the spinous process of a vertebra 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 - an unstable fracture dislocation of the thoracolumbar junction of the spine
  • Distraction is an where there is 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.

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Risk of spinal cord injury

Vertebral fractures of the thoracic vertebrae, lumbar vertebrae or sacrum are usually associated with major trauma and can cause spinal cord injury 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:

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 injury - 2 points
  • Incomplete injury of cord/conus medullaris - 3 points
  • Complete injury of cord/conus medullaris (complete) - 2 points
  • Cauda equina syndrome - 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.

Source of the article : Wikipedia



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