Spinal fractures in youth and middle age require an act of violence, such as industrial accident or a road traffic accident. Most fractures are stable and do not require any form of surgical correction.
Given the relationship of the spine however, to the spinal cord and nerve roots, spinal fractures should be evaluated carefully as there are some which carry a risk of permanent nerve impairment. Most nerve impairment however, occurs at the time of the injury and may be recoverable if the area affected is decompressed. Some damage is regrettably permanent, due to the damage done to the nerves at the time of the accident.
Another form of spinal fracture is that related to osteoporosis and this tends to occur more commonly in the elderly. These fractures although painful, very rarely require any form of invasive treatment but clearly the diagnosis of osteoporosis requires an underlying condition which itself needs to be treated.
Spinal fractures are evaluated by x-ray, MRI and CT scans. A decision is made regarding their stability and if they are stable and minor, then they can often be treated using some form of brace which is generally worn for a period of around three months and further x-rays taken to ensure that the fracture has healed adequately. Physical therapy may well then be used to unstiffen the spine and regain strength and mobility.
More serious fractures may require stabilisation, this is largely carried out posteriorly, in other words, through the back with the use of screws and rods. Occasionally the fracture is so severe, the fragments need to be removed from the front and the removed bone replaced with some form of cage. This form of surgery is done through the front of the spine which may involve an incision through the abdomen, chest or neck. This surgery is sometimes required to reconstruct a spine if a fracture has healed in a poor position with less invasive management.