SPINE FRACTURE, LOWER THORACIC & LUMBAR REGION |
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General Information
DEFINITION--A complete or incomplete break in a bone in the lower thoracic or the lumbar spine. The lowest part of the thoracic spine and the first two bones of the lumbar spine are the most common sites for fractures in this region. This is due to the change in the spine's curvature and the lack of rib-cage support.
BODY PARTS INVOLVED
Bones of the lower thoracic and lumbar spine.
Joints between segments of the spine.
Soft tissue around the fracture site, including muscles, nerves, tendons, ligaments, periosteum (covering to bone), blood vessels and connective tissue.
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SIGNS & SYMPTOMS
Severe pain in the spine.
Swelling and bruising around the fracture.
Visible deformity if the fracture is complete and the bone fragments separate enough to distort normal back contours.
Tenderness to the touch.
Paralysis of legs and muscles in the pelvis, if the spinal cord is injured.
CAUSESDirect blow or indirect stress to the bone. Indirect stress can be excessive spinal flexing, extension, rotation or bending. Common situations that cause this fracture include:
A hard fall in which the person lands on the heels.
Sitting down hard, especially for an older person with osteoporosis.
A heavy load falling on a bent back, such as someone jumping on a swimmer's back.
RISK INCREASES WITH
Sledding or toboggan riding.
"Horseplay" around swimming pools and diving boards.
Contact sports.
History of bone or joint disease, especially osteoporosis.
Obesity.
Poor nutrition, especially calcium deficiency.
If surgery or anesthesia are needed, surgical risk increases with smoking and use of drugs, including mind-altering drugs, muscle relaxants, antihypertensives, tranquilizers, sleep inducers, insulin, sedatives, beta-adrenergic blockers or corticosteroids.
HOW TO PREVENT
Build your strength with a good conditioning program before beginning regular athletic practice or competition. Increased muscle mass helps protect bones and underlying tissue.
Ensure an adequate calcium intake (1000mg to 1500mg a day) with milk and milk products or calcium supplements.
WHAT TO EXPECT
APPROPRIATE HEALTH CARE
Traction.
Surgery (sometimes) to set and immobilize the fracture.
Long rehabilitation program and physical therapy, if the spinal cord is damaged.
DIAGNOSTIC MEASURES
Your own observation of symptoms.
Medical history and exam by a doctor.
X-rays of the spine.
POSSIBLE COMPLICATIONS
AT THE TIME OF FRACTURE:
Shock.
Pressure on or injury to the spinal cord, nearby nerves, ligaments, tendons, blood vessels or connective tissues. AFTER TREATMENT OR SURGERY:
Excessive bleeding.
Impaired blood supply to the healing bone.
Avascular necrosis (death of bone cells) due to interruption of blood supply.
Arrest of bone growth in young people.
Infection introduced during surgical treatment.
Unstable or arthritic joint after repeated injury.
Paralysis (sometimes).
PROBABLE OUTCOMEThe average healing time for this fracture is 6 to 12 weeks. Healing is considered complete when there is no pain or motion at the fracture site and when X-rays show complete bone union.
HOW TO TREAT
NOTE -- Follow your doctor's instructions. These instructions are supplemental.
FIRST AID
Cut away clothing, if possible, but don't move the injured area to do so.
Use a spineboard to immobilize the back while transporting the injured person to an emergency facility.
Elevate the injured part above the level of the heart to reduce swelling and prevent accumulation of excess fluid. To do so, elevate the foot of the spineboard or the bed.
Keep the patient warm with blankets to decrease the possibility of shock.
Treatment consists of surgically or non-surgically realigning and holding the spine in its correct position. Realignment should be done as soon as possible after injury. Six or more hours after the fracture, bleeding and displacement of body fluids may lead to shock. Also, many tissues lose their elasticity and become difficult to return to a normal position.
CONTINUING CARE
Immobilization will be necessary. This may mean immobilization of the patient with bed rest in a rehabilitation facility, or immobilization of the fractured bones with internal wires or screws. A cast is rarely used.
After treatment, use ice massage if possible. Fill a large Styrofoam cup with water and freeze. Tear a small amount of foam from the top so ice protrudes. Massage firmly over the injured area in a circle about the size of a softball. Do this for 15 minutes at a time, 3 or 4 times a day.
After 72 hours, you may apply heat instead of ice if it feels better. Use heat lamps, hot soaks, hot showers or heating pads.
Take whirlpool treatments, if available.
Massage gently and often to provide comfort and decrease swelling.
MEDICATIONYour doctor may prescribe:
General anesthesia, local anesthesia or muscle relaxants to make bone manipulation possible.
Narcotic or synthetic narcotic pain relievers for severe pain.
Stool softeners to prevent constipation due to inactivity.
Acetaminophen (available without prescription) for mild pain after initial treatment.
Antibiotics to fight infection if the skin is broken or surgery is needed.
ACTIVITYBegin reconditioning and rehabilitation after clearance from your doctor. Resume normal daily activities gradually after treatment.
DIET
Drink only water before manipulation or surgery to treat the fracture. Solid food in your stomach makes vomiting while under anesthesia more hazardous.
During recovery, eat a well-balanced diet that includes extra protein, such as meat, fish, poultry, cheese, milk and eggs. Increase fiber and fluid intake to prevent constipation.
REHABILITATIONBegin daily rehabilitation exercises when movement is comfortable. Use ice massage for 10 minutes prior to exercise. See section on rehabilitation exercises.
CALL YOUR DOCTOR IF
You have signs or symptoms of a spine fracture.
Any of the following occurs after treatment or surgery:
Numbness, complete loss of feeling or paralysis below the fracture site.
Increased pain, swelling or drainage in the surgical area.
Signs of infection (headache, muscle aches, dizziness, or a general ill feeling and fever).
Nausea or vomiting.
Constipation.
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