Lumbar Fracture

ExitCare ImageA fracture of a bone is the same as a break in the bone. A fracture in the lumbar area is a break that involves one of many parts that make up the 5 bones of the low back area. This is just above the pelvis.

CAUSES

Most of these injuries occur as a result of an accident such as:

  • A fall.

  • A car accident.

  • Recreational activities.

  • A smaller number occur due to:

  • Industrial, farm, and aviation accidents.

  • Gunshot wounds and direct blows to the back.

  • Parachuting incidents.

Most lumbar fractures affect the "building blocks" or the main portion of the spine known as the "vertebral bodies" (see the image on the right). A smaller number involve breaks to portions of bone that extend to the sides or backward behind the vertebral body. In the elderly, a sudden break can happen without an apparent cause. This is because the bones of the back have become extremely thin and fragile. This condition is known as osteoporosis.

SYMPTOMS

Patients with lumbar fractures have severe pain even if the actual break is small or limited, and there is no injury to nearby nerves. More severe or complex injuries involving other bones and/or organs may include:

  • Deformity of the back bones.

  • Swelling/bruising over the injured area.

  • Limited ability to move the affected area.

  • Partial or complete loss of function of the bladder and/or bowels. (This may be due to injury to nearby nerves).

  • More severe injuries can also cause:

  • Loss of sensation and/or strength in the legs, feet, and toes.

  • Paralysis.

DIAGNOSIS

In most cases, a lumbar fracture will be suspected by what happened just prior to the onset of back pain. X-rays and special imaging (CT scan and MRI imaging) are used to confirm the diagnosis as well as finding out the type and severity of the break or breaks. These tests guide treatment. But there are times when special imaging cannot be done. For example, MRI cannot be done if there is an implanted metallic device (such as a pacemaker). In these cases, other tests and imaging are done.

If there has been nerve damage, more tests can be done. These include:

  • Tests of nerve function through muscles (nerve conduction studies and electromyography).

  • Tests of bladder function (urodynamics).

  • Tests that focus on defining specific nerve problems before surgery and what improvement has come about after surgery (evoked potentials).

TREATMENT

Common injuries may involve a small break off of the main surface of the back bone. Or they may be in the form of a partial flattening or compression of the bone. Hospital care may not be needed for these. Medicine for pain control, special back bracing, and limitations in activity are done first. Physical therapy follows later.

Complex breaks, multiple fractures of the spine, or unstable injuries can damage the spinal cord. They may require an operation to remove pressure from the nerves and/or spinal cord and to stabilize the broken pieces of bone. Each individual set of injuries is unique. The surgeon will take into consideration many things when planning the best surgical approach that will give the highest likelihood of a good outcome.

HOME CARE INSTRUCTIONS

There is pain and stiffness in the back for weeks after a vertebral fracture. Bed rest, pain medicine, and a slow return to activity are generally recommended. Neck and back braces may be helpful in reducing pain and increasing mobility. When your pain allows, simple walking will help to begin the process of returning to normal activities. Exercises to improve motion and to strengthen the back may also be useful after the initial pain goes away. This will be guided by your caregiver and the team (nurses, physical therapists, occupational therapists, etc.) involved with your ongoing care. For the elderly, treatment for osteoporosis may be needed to help reduce the risk of fractures in the future.

Arrange for follow-up care as recommended to assure proper long-term care and prevention of further spine injury. The failure to follow-up as recommended could result in permanent injury, disability, and a chronic painful condition.

SEEK MEDICAL CARE IF:

  • Pain is not effectively controlled with medication.

  • You feel unable to decrease pain medication over time as planned.

  • Activity level is not improving as planned and/or expected.

SEEK IMMEDIATE MEDICAL CARE IF:

  • You have increasing pain, vomiting, or are unable to move around at all.

  • You have numbness, tingling, weakness, or paralysis of any part of your body.

  • You have loss of normal bowel or bladder control.

  • You have difficulty breathing, cough, fever, chest or abdominal pain.