Low Back Fracture Injuries

Truck and car crashes may cause fractures in the low back. A fracture of a lumbar (low back) vertebra causes severe pain, aggravated by movement. When it involves damage to the spinal cord or nerves, there may also be numbness, tingling, or weakness in the limbs, and bowel or bladder dysfunction.

 Low back injuries can appear in many forms, including vertebral fractures, ruptured or bulging discs, and damage to nerves, ligaments, tendons, and muscles. An injury can involve aspects of any or all of these.

  A high-energy crash may also produce brain injury and loss of consciousness, distracting attention from the low back fracture injury.

 There are several varieties of low back vertebral fractures:

Compression fractures

Compression fractures are small breaks in the bone that reduce the height of the vertebra. If bone density is already reduced due to osteoporosis, one is more vulnerable to the collapse of the vertebra due to trauma. An accident such as a rear-end collision can have life-altering effects, suddenly changing one’s condition from a silent vulnerability to acutely painful and debilitating.

 A wedge fracture is one common form of compression fracture. It involves the collapse of the front side of the vertebra. Such compression fractures can lead to chronic pain, disfigurement, impaired activities of daily living, height loss, and increased risk of pressure sores. With that comes an increased risk of depression and psychological distress that often commonly accompany chronic pain and loss of quality of life.

  Smokers are somewhat more at risk than non-smokers. The people most vulnerable to compression fractures of spinal vertebra are post-menopausal women with reduced bone density associated with osteoporosis.

 Burst low back fracture injuries

In our practice, we most often see burst fracture injuries in clients hit hard from the rear by tractor trailers, as those are collisions involving  high kinetic energy.

 In a burst fracture, shards of bone tissue from the vertebra spread out in all directions and penetrate surrounding tissues and sometimes the spinal canal. The severity of a burst fracture depends upon the severity of the deformity, degree of canal compromise, the loss of vertebral body height, and degree of neurologic deficit.

 Generally more severe than compression fractures, herniated discs and many other back injuries, burst fractures often cause long-term neurological damage. Burst fractures are more severe than many other back injuries for two reasons. First, when the entire margin of the vertebral body is crushed the spine is much less stable than in a wedge-type compression fracture  Second, fragments of bone spread out in all directions,  bruising the spinal cord and potentially causing paralysis or other neurologic injuries.

 Immediate hospitalization is required in cases of burst fracture because of the potential for spinal cord damage, including potential paralysis. Extensive radiological examinations, including MRI (magnetic resonance imaging), CT, and X-rays, are necessary. Surgery is often required.

  In younger patients, surgery involves one of several techniques for spinal fusion and stabilization.  Non-surgical treatment usually includes a full-body brace, custom-fitted to the patients' body, which must be worn 24/7 for months. Physical therapy helps the patient rebuilt muscle and regain physical function.  

 When older people with brittle bones have burst fractures, it is challenging to attach plates and screws to the bone. Doctors often treat these with vertebroplasty, injecting bone cement into the damaged vertebra to gain stability and support for the spine.

 Burst fracture injuries are excruciating. Pain management treatment may extend for a long time, involving its potential complications such as drug dependency or addiction. Over the patient’s lifetime, pain, loss of function, diminished appearance, and severe neurological deficits may develop.

 Seat Belt “Chance”  fractures

 A Chance fracture (named after Dr. Chance, who defined it)  is an unstable spine fracture, usually at the thoracolumbar junction, vertebra T10-L2, This accounts for about half of all spinal injuries outside of the cervical spine.

Chance fractures were more common before shoulder harnesses became common. The upper body is thrown forward without an effective shoulder harness, especially in a head-on collision. Suppose the pelvis is stabilized only by a lap seat belt, upon sudden deceleration. In that case, the spine suddenly bends over the lap seat belt, which serves as a fulcrum, resulting in the separation of the middle and posterior elements of the spine. This is why it is important to wear a shoulder harness seatbelt.

A Chance fracture is a horizontal fracture extending from posterior to anterior through the spinous process, pedicles, and vertebral body. It is an unstable horizontal fracture extending from rear to front through the vertebral body spinous process and pedicles. In about half of Chance fractures, there are injuries to internal organs, especially spleen, bowel and bladder ruptures.

Emergency physicians easily overlook Chance fractures because there are no obvious neurological symptoms. However, early recognition of this injury is essential as a delay in diagnosis significantly impacts outcomes. Treatment often involves stabilization of the spine with a brace or cast. More severe cases with neurological symptoms may require surgery.

Rotation low back fracture injuries

With rotation fracture-dislocation, both bone and soft tissue around a vertebra are injured. This may cause spinal cord compression. Treatment involves surgery to stabilize the spine, generally with plates, screws, rods, or cages.

Permanent Impairments after Low Back Fracture Injuries

The  American Medical Association Guides to Evaluation of Permanent Impairment   specifies physical impairment ratings for various injuries. Physical impairment is not the same thing as occupational disability. A person with a relatively low impairment rating may be completely disabled from a physically demanding occupation. But a person with the same physical impairment rating may be fully capable of doing an office job. We may also consider evaluation by a vocational rehabilitation expert to evaluate the real-world disability.

 If you or a loved one have suffered a low back fracture injury, call us at 404-253-7862.