14 August, 2017
A Fracture of the Lumbar Spine
Fractures of the lumbar spine, five vertebrae found at the lower end of the back, can have serious long-term consequences. The vertebrae surround and protect the spinal cord, so damage to the vertebrae can also damage the spinal cord. Fractures of the lumbar spine occur more frequently than fractures of the thoracic spine, because the lumbar vertebrae are more mobile than the thoracic vertebrae.
Most fractures of the lumbar spine are caused by trauma, according to the American Academy of Orthopaedic Surgeons. About 40 percent occur as a result of automobile accidents, 20 percent from falls and another 40 percent from gunshot wounds and other types of accidents, according to Dr. Keith Wilkinson of Michigan State University. Most occur in people under age 30. Compression fractures caused by weakened bone density can also occur in the lumbar spine and occur mostly in elderly women.
Lumbar fractures fall into several classifications. Flexion fractures include compression fractures, in which the vertebra collapses at the front but not the back; and axial burst fractures, in which the vertebra collapses at both the front and the back. Extension fractures, sometimes called Chance fractures, occur when the vertebra literally pulls apart, as in an accident where the pelvis is stabilized but the upper body moves violently forward. Rotation fractures occur when the body bends violently sideways or when the vertebrae are displaced, with one moving away from the one next to it, the AAOS explains.
Lumbar fractures cause moderate to severe pain that worsens with movement. Weakness, numbness and tingling in the affected area occurs if the spinal cord sustains damage, according to the AAOS. Bowel and bladder control may also be lost if spinal cord damage occurs. Nearly 60 percent of people with lumbar spine injuries have serious long-term consequences or side effects, Wilkinson warns.
People who sustain violent injuries to the lumbar spine should not be moved without immobilizing the spine, unless they’re in a life-threatening situation, such as a burning building. Stable injuries, that is, injuries in which the damaged vertebrae aren’t likely to shift, can often heal if stabilized for 6 to 12 weeks in a brace or cast, the AAOS reports. Steroid medications may be given to reduce swelling and inflammation if spinal cord compression is present, to preserve as much function as possible, orthopedic surgeon Edwin Haronian of Pomona Orthopedics explains. Surgery may be necessary for unstable fractures, to prevent spinal cord damage. The unstable pieces of the vertebra are removed, a process called decompression or laminectomy. Screws, rods and other mechanical devices may be placed to stabilize the spine.
Fractures of the lumbar spine can result in paralysis if severe damage to the spinal cord occurs. Other complications include development of blood clots in the legs from immobility, which can then break off and travel to the lungs or other part of the body. Blood clots block blood flow and can cause stroke or pulmonary embolism, which can be fatal. Pneumonia and pressure sores can also occur from immobility. Infection and bleeding can occur after spinal surgical repair, and the vertebra may not heal well.
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