Burst fractures are categorized by the severity of the deformity and the severity of the spinal canal compromise, as well as the degree of loss of vertebral height and neurologic injury. In a burst fracture, the margins of the vertebral body spread out in all directions. By crushing the entire margin of the vertebral body, the spine loses its stability. There may also be loss of strength, sensation, and reflexes below the level of the injury. The bony fragments can spread out and bruise the spinal cord causing partial neurologic injury or paralysis.
At the scene of the accident, if the victim complains of severe back pain they should not be put into a sitting position. If they stand or walk with a burst fracture, they may increase their neurologic injury.
The physician will need to do x-rays, a CAT scan, and possibly an MRI to determine:
- the level of the fracture
- the type of fracture (compression, burst, or fracture dislocation)
- the amount of spinal canal compromise
- spinal angulation
- the amount of soft tissue trauma
- ligament disruption
Stable Burst Fracture
A stable burst fracture has little to no neurologic injury and the posterior column is uninjured and remains functional and can be treated without surgery. Treatment with a brace can be very effective. The brace is worn for 8-12 weeks to ensure adequate healing. Physical therapy will be prescribed once the brace is removed.
Unstable Burst Fracture
A burst fracture is ruled unstable if there is:
- neurologic injury
- angulation of the spine is greater than 20 degrees
- there is dislocation of the spine
- loss of more than 50% of anterior vertebral body height
- there is greater than 30% spinal canal compromise
Unstable burst fractures do better with early surgery. A reduction maneuver may be performed to straighten the spine and spinal fusion, with bone graft, to help injured vertebrae heal. Fragments pressing on the spinal canal, may be moved into a better position by a spinal laminectomy. After any stabilizing surgery, some type of bracing is required for 8-10 weeks. Once the bracing is removed, physical therapy will be necessary to help return strength to the trunk and lower extremities.
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