Spinal fractures occur when one or more vertebrae break due to trauma, osteoporosis, or tumor infiltration (metastasis).
Depending on severity, fractures can cause pain, nerve compression, or spinal instability that threatens the spinal cord.
Modern surgical approaches — including percutaneous fixation, vertebroplasty, kyphoplasty, and instrumented stabilization — allow for safe restoration of spinal alignment and early mobility.
Types of Spinal Fractures
1. Traumatic Fractures
Caused by accidents, falls, or sports injuries, these fractures may range from simple compression to burst or fracture–dislocation injuries.
- Mild compression fractures: usually treated with bracing and rest.
- Unstable burst or fracture–dislocation: require surgical stabilization to protect the spinal cord.
Common symptoms: sudden severe back pain, numbness or weakness in limbs, and difficulty walking.
2. Osteoporotic Fractures
Common in elderly patients, caused by fragile bones due to osteoporosis.
Even minimal trauma or spontaneous movement can lead to collapse of a vertebral body, resulting in kyphotic deformity and chronic pain.
Minimally invasive procedures like vertebroplasty or balloon kyphoplasty can restore height and relieve pain effectively.
3. Metastatic & Pathological Fractures
Occur when cancer spreads to the spine, weakening the bone and causing collapse.
These fractures can lead to spinal cord compression and severe pain.
Treatment combines surgical stabilization, tumor decompression, and adjuvant therapy (radiotherapy or systemic treatment).
Diagnosis
Diagnosis begins with X-rays and MRI to evaluate the fracture pattern, spinal cord compression, and bone quality.
CT scan provides detailed assessment of bone fragments and canal compromise.
For cancer-related lesions, PET-CT or biopsy may be used to identify the underlying disease.
Clinical assessment focuses on pain level, neurological function, and spinal alignment./p>
Treatment Options
1. Conservative Management
For stable fractures without neurological symptoms:
- Rest and bracing (TLSO or cervical collar)
- Pain management
- Physical therapy and osteoporosis treatment in older adults
2. Minimally Invasive Procedures
- Vertebroplasty: injection of bone cement to stabilize the fracture and reduce pain.
- Kyphoplasty: balloon expansion followed by cement injection to restore vertebral height and alignment.
These techniques are performed under local or general anesthesia and allow same-day discharge in most cases.
3. Surgical Decompression & Stabilization
For unstable, metastatic, or neurologically compromised fractures, microsurgical decompression is combined with stabilization using screws and rods.
The goals are to:
- Relieve pressure on the spinal cord and nerves
- Correct deformity and restore alignment
- Provide immediate stability and pain relief
Modern percutaneous and minimally invasive fixation techniques reduce blood loss and recovery time while maintaining long-term strength.
4. Combined Oncologic & Reconstructive Approach
In metastatic cases, tumor resection, vertebral reconstruction, and cement-augmented screws may be used alongside radiotherapy or systemic oncology care.
This multidisciplinary approach offers both local control and pain relief.
5. Surgical Strategy Based on Tumor Type
The surgical approach to spinal tumors varies depending on the histopathological diagnosis:
- In metastatic tumors, the goal is often separation surgery — creating a safe margin between the tumor and the spinal cord before adjuvant radiotherapy.
- In uncertain or diffuse lesions, biopsy-only procedures are performed first to establish a definitive diagnosis and guide multidisciplinary treatment.
- For primary spinal bone tumors (such as chordoma, osteosarcoma, or Ewing sarcoma), the objective is radical en-bloc resection whenever feasible, aiming for oncological cure and long-term control.
The treatment plan is always adapted to the tumor’s pathology, location, and biological behavior.
Recovery & Follow-Up
Most patients are mobilized within 24–48 hours after stabilization.
Physiotherapy focuses on posture, muscle strengthening, and balance training.
Follow-up imaging (X-ray or MRI) is performed at 6 weeks, 3 months, and 1 year to assess bone healing and hardware stability.
For cancer-related cases, long-term coordination with oncology ensures optimal outcomes.
When to See a Neurosurgeon
Seek immediate attention if you experience sudden back pain after a fall or minor trauma, numbness, weakness, or loss of bladder/bowel control.
Early diagnosis and stabilization prevent permanent spinal cord injury and chronic deformity.