Traumatic Lumbar Spine Fractures and Dislocations
Trauma from a fall, car crash or sports collision may injure your lower back in various ways. It can damage your spinal cord and vertebrae, disrupt your discs and ligaments, and, in severe cases, can affect your nerves too.
There are several treatment options available, including, but not limited to, spinal surgery.
About your lumbar spine
Your spine stretches from your neck to your hips. Your lumbar spine (lower back) is the bottom segment, involving 5 vertebrae known as L1-L5.
Vertebrae are like hollow bony building blocks. Sandwiched between each one is a disc that cushions shock and provides flexibility.
The spinal cord is a tight bundle of nerves that run from your brain stem and down through your spinal column, stopping at your L1 vertebrae where it turns into a different nerve structure known as the cauda equina. A pair of nerve roots branch off from each vertebral segment. The nerves in your lumbar spine help you move your lower body.
Various muscles and ligaments support your lumbar spine.
What causes a lumbar fracture?
A fracture is the cracking or breaking of a bone. Spinal fractures can happen through high-energy traumas such as a car crash or throw from a horse. However, if your spine is weakened by osteoporosis, a smaller event like a fall may be traumatic enough to cause a spinal fracture.
What are the symptoms of a lumbar fracture?
If you’ve fractured your spine, you’re likely to experience moderate to severe back pain that gets worse when you move. If the fracture has affected your spinal cord or nerves, you may also experience bowel or bladder dysfunction along with numbness, tingling or weakness in your legs.
If you’ve sustained other injuries, have lost consciousness or are in shock, you may be so distracted by those symptoms that you don’t notice your back pain.
That’s why your doctors will always thoroughly examine your spine if you’ve been in a car crash or experienced a similarly high-energy event.
They’ll also pay very close attention to which particular L1-L5 vertebrae is injured and whether that’s caused knock-on damage to your spinal cord and nerves. If you have an L2 lumbar fracture or lower, you won’t have a spinal cord injury as that stops at L1. However, it is still possible to injure the nerves in your lower spine.
Treatment for lumbar fractures
Treatment for lumbar fractures depends on the location and severity of your injury, particularly whether or not your nerves are involved.
Not all fractures require surgery and many times a full recovery can be expected if there is no neural (nerve) injury.
First Aid
After an injury to the spine, the first concern is to protect your nerve structures. That’s done by minimising any movement of your spine until we’re able to assess its stability through careful examination and investigation.
Investigations
Common investigations in spine trauma are X-rays and CT scans. Both are very good at assessing the alignment and integrity of the bones of the spine.
CT can exclude instability in 98% of cases of spinal trauma. However where there is concern about the nerves, discs and ligaments then an MRI can add essential detail that enables us to diagnose the full extent of the injury.
Once stability or instability of the spine is established then your treating team can develop a management plan.
What if my spine is unstable after a spinal trauma?
Spinal instability means that your spine is now moving more than it should, compromising its ability to support your body properly.
If your spine is unstable, then a surgeon trained in assessing the spine will decide if surgery is warranted. In some cases a brace can be an appropriate device to help stabilise the spine while it is healing. Other times a period of bed rest can also be prescribed. In severe cases of spinal trauma, surgery is the recommended treatment to avoid complications associated with prolonged bed rest and immobility. Modern spine surgery techniques can help to stabilise the spine and allow return of mobility and function.
Nerve injuries relating to a lumbar spine fracture
Thankfully, injuries in the lumbar spine rarely threaten the spinal cord as it terminates at the L1 level.
The nerves in your lumbar spine are mostly found in the cauda equina, a lash of nerves shaped a bit like a horse’s tail. The cauda equina is made up of the lumbar and sacral nerve roots. It supplies the legs and controls bladder and bowel outlets.
Nerve injury in the lumbar spine can have differing degrees of impact on the cauda equina depending on which vertebrae are fractured. Generally speaking, the higher the injury is in your lumbar spine, the greater the neurological deficit.
A nerve injury at L1 or L2 usually means you can still walk, with or without aids. If the nerve injury is above L3, then many of the important muscles controlling the legs are too weak to allow independent walking.
How to sit with a fractured vertebrae
Your aim is to reduce the pressure on your spine to help it heal. Whether you’re lying down, standing or sitting, try to do so with a good posture that keeps your spine in a neutral position.
That means sitting up straight and tall. Using a high-backed chair like a dining chair will make this easier than slumping into a soft sofa. A high-backed chair with arms is even better, as you can push yourself up with them.
Recovery from spine injury and surgery
Many people feel anxious at the thought of surgery to stabilise their spine. We do our best to reassure you about the process and results of surgery.
When you’ve experienced a traumatic spine fracture that has potentially serious consequences, surgery aims to reduce the impact of your injury and maximise your long term function.
Surgery is also only one part of your treatment. Recovery and rehabilitation can be a lengthy process after a traumatic fracture to your lumbar spine. You may need ongoing treatment and support for over a year.
How can the Victorian Orthopaedic Spine Service help?
Dr David Edis is a skilled orthopaedic surgeon with many years of experience in supporting patients with traumatic lumbar spine fractures.
Our care pathway is designed to ensure you only progress to surgery if you really need it but, if you do, we make the process as easy as possible for you and provide ongoing follow-up as you recover.
