Trauma and Fractures

Spine fractures caused by trauma–a sudden blow or injury to the vertebrae–can occur anywhere on the spine, including:

  • Bones in the neck (cervical spine)
  • Bones in the upper back (thoracic spine)
  • The lower back (lumbar spine)
  • The section of connected bone at the very bottom of the spinal column (sacrum)

Car accidents, falls and sports injuries are examples of trauma that can cause spine fractures.

The first symptom of a broken bone is usually pain unless the spinal cord also has been injured, which can produce weakness, paralysis and/or lack of sensation. Depending on the location of the fracture, the damaged structures can injure the spinal cord or spinal nerves nerves that lead to pain in the arms or legs, or affect the bowel, bladder or sexual organs.

Treatment of spinal fractures is aimed at realigning the broken pieces and keeping them in alignment until the bone has healed. Healthy broken bones will naturally form more bone tissue around the broken edges to “knit” the broken edges. Specific treatment of traumatic spine fractures depends on the location of the fracture, its severity and how it impacts nearby tissue and nerves.

Some fractures heal well with external bracing. Cervical fractures can sometimes be treated with a halo vest (a ring attached to the skull and attached to a vest on the chest). Other fractures may require surgical stabilization, with implanted screws, hooks and connecting rods, and fusing that portion of the same spine (placing bone graft to help the bones grow together).

There are some fractures which my need to be observed to determine whether bone will heal on their own or if surgery will be needed. Surgery is recommended for many patients who suffer neurologic injury at the time of their fracture to remove any bone or disc material that is still compressing the neural structures, and to stabilize that part of the spine to minimize additional trauma to that region.


Spinal stenosis is a medical condition in which the spinal canal narrows and compresses the spinal cord and nerves. This is usually due to the spinal degeneration that commonly occurs with aging. It can also sometimes be caused by osteoporosis, spinal disc herniation, or a tumor.

Spinal stenosis may affect the cervical, thoracic or lumbar spine.

Symptoms include:

  • Pain
  • Weakness
  • Tingling of the legs

Surgery for spinal stenosis is the most common spinal operation in people over the age of 50. However, spinal stenosis caused by developmental narrowing of the spinal canal may occur in people in their 20s and 30s.

Operations used to treat stenosis include:

  • Anterior Cervical Discectomy and Fusion — A small incision in the front of the neck is used to access the upper spine. The ruptured or herniated disc is removed and replaced with a small bone plug, which eventually grows to connect the two adjacent vertebrae.
  • Cervical Corpectomy — Part of the vertebra and discs are removed and replaced with a bone graft or a metal plate and screws to support the spine.
  • Decompressive Laminectory — The roof of the vertebrae, called the lamina, is surgically removed. The procedure also may include removing part of the disc or fusing the vertebrae (spinal fusion).
  • Foramenotomy — The area where nerve roots leave the spinal canal, called the foramen, is removed. This procedure can be performed using a minimally invasive approach with an endoscope, an instrument that allows the surgeon to see inside the body through a tiny incision. The surgeon can then use other tiny incisions to perform the surgery, avoiding the discomfort and muscle atrophy associated with the traditional open technique that uses a large incision.
  • Laminoplasty — The compressive bone in the back of the neck is gently lifted off of the spinal cord creating a new “roof” over the spinal cord and nerve roots. This procedure effectively decompresses the spinal cord over multiple segments without the need for fusion or hardware. It also minimizes the chance of spinal instability or deformity that may result from the traditional laminectomy procedure.
  • Laminotomy — Only a small portion of the lamina is removed.
  • Medial Facetectomy — Part of the bone structure in the spinal canal, called the facet, is removed.
  • Cervical Disc Replacement — Instead of fusing the affected area, the natural disc material is replaced with a metal and plastic prosthesis that maintains or restores the motion segment. This will hopefully prevent degeneration of the next disc level.

Cervical Stenosis

Stenosis in the neck, also called the cervical spine, affects the upper part of the body including the arms and hands. Stenosis is the narrowing of the bony canal that protects the spinal cord and its branching nerves to the point where it injures the spinal cord or nerves.

This may be caused by a number of conditions including:

  • Bone spurs
  • Rupture of the spinal discs

Cervical stenosis may cause pain, numbness, or weakness in the legs. The pain may move from one part of the body to another but is often most noticeable in the neck.

If the stenosis is severe and is not responding to other treatment methods, surgery to widen the spinal canal may be necessary. Because bone continues to deteriorate, additional treatment may be needed several years after even successful surgery.

Lumbar Stenosis

Stenosis in the lower back is called lumbar stenosis. It is often characterized by radiating pain in the buttocks and legs.

Frequently people afflicted with lumbar stenosis have varying degrees of low back discomfort. The pain typically occurs most often during activities and is relieved by resting, sitting or bending forward. In some cases, the pain is centralized in the lower legs and feet. In severe cases, it also can impact continence (bowel and bladder control) and sexual function.

The initial treatment for stenosis is to treat the symptoms rather than the condition itself. These treatments include:

  • Rest
  • Posture changes, such as lying with the knees drawn up to the chest or leaning forward while walking, may relieve the pressure on the nerves
  • Medication such as aspirin or ibuprofen to relieve inflammation and pain
  • Physical therapy
  • Losing weight
  • Corticosteroid injections to reduce inflammation and relieve pain
  • A cervical collar

If several months of treatment have not improved the symptoms, and if the stenosis is severe, surgery to widen the spinal canal may be necessary. Because bone continues to deteriorate, additional treatment may be needed several years after even successful surgery.

Disc Herniation

A spinal disc herniation is a medical condition affecting the spine, in which a tear in the outer, fibrous ring of an intervertebral disc allows the soft, central portion to bulge out. This tear in the disc ring may result the patient feeling severe pain.

Anti-inflammatory treatments are commonly used for pain associated with disc herniation, protrusion, bulge, or disc tear.

Cervical Disc Herniation

The cervical spine consists of the top seven bones, called vertebrae, in your spine located between the skull and chest.

Cervical disc herniation usually develops in people aged 30 – 50. It may originate from some sort of trauma or injury to the cervical spine.

The first symptom of cervical disc herniation is usually neck pain. Others symptoms may include:

  • Pain in one arm or in both arms
  • Limited head and neck motion, especially turning to the side of the herniated disc
  • Hyperactive reflexes
  • Spasticity
  • Loss of bladder or bowel control, erectile dysfunction

Symptoms can typically be eased with pain medication and conservative (non-surgical) treatments. All treatments for a cervical herniated disc are essentially designed to help resolve the arm pain. The weakness and numbness/tingling usually will resolve with time.

Thoracic Disc Herniation

The thoracic spine consists of the 12 vertebrae between your neck and lower back. The ends of your ribs, although not attached to the spine, rest in indentations in the thoracic vertebrae that help support the ribs. This arrangement also makes the thoracic vertebrae more stable than other vertebrae.

Disc herniation in the thoracic spine is relatively rare compared to the lumbar vertebrae in the lower back and the cervical vertebrae in the neck. Thoracic disc herniations account for less than 1 percent of all protruded discs.

The progressive wear and tear that occurs with degenerative disc disease increases the risk of injury via trauma. Risk factors for thoracic disc herniation include:

  • Age
  • Trauma
  • Smoking
  • Obesity
  • Sedentary lifestyle
  • Poor physical fitness

When a thoracic disc hernation occurs, symptoms may include:

  • Pain in the upper back
  • Numbness, pain or tingling from the upper back and around the chest
  • Leg weakness
  • Chest pain

Most often, thoracic disc herniation is treated with bed rest and pain medication. However, surgery may be recommended if the condition doesn’t respond to conservative treatment or if the disc is impinging on the spinal cord and causing symptoms or signs of spinal cord dysfunction.

Surgical treatment consists of removing the damaged disc or discs, a procedure called a discectomy. It also may include removing the lamina, the upper part of the vertebrae, to give the spinal cord more room.

Lumbar Disc Herniation

The lumbar spine consists of the five vertebrae in the lower part of the spine, each separated by a disc, also called a lumbar disc. The discs in this part of the spine can be injured by certain movements, bad posture, being overweight and disc dehydration that occurs with age.

Although the lumbar vertebrae are the biggest and strongest of the spinal bones, risk of lumbar injury increases with each vertebrae down the spinal column because this part of the back has to support more weight and stress than the upper spinal bones.

The lumbar disc is the most frequent site of injury in several sports including gymnastics, weightlifting, swimming and golf, although athletes in general have a reduced risk of disc herniation and back problems.

Symptoms of disc herniation in the lower back are slightly different from symptoms in the cervical or thoracic parts of the spine. The spinal cord ends near the top lumbar vertebrae but the lumbar and sacral nerve roots continue through these spinal bones. A lumbar disc herniation may cause:

  • Lower back pain
  • Pain, weakness or tingling in the legs, buttocks and feet
  • Difficulty moving your lower back
  • Problems with bowel, bladder or erectile function, in severe cases

Conservative treatment of lower disc pain usually is successful over time. It includes:

  • Pain medication or pain therapies such as ultrasound, massage or transcutaneous electrical nerve stimulation
  • Anti-inflammatory medication such as aspirin, ibuprofen and acetaminophen
  • Physical therapy
  • Steroid injections
  • Education in proper stretching and posture
  • Rest

However, surgery may be recommended if your pain doesn’t respond to conservative treatment in two to four weeks, your condition affects your bowel or bladder function, or if it threatens permanent nerve damage. Only about 10 percent of adult lumbar disc patients require surgery and even fewer children and adolescents.


Everyone’s spine has natural curves. These curves round our shoulders and make the lower back curve slightly inward. But some people have spines that also curve from side to side, a common condition called scoliosis. Scoliosis is defined as curvature of the spine greater than 10 degrees, as measured on an X-ray. Anything less is simply due to normal variation. On an X-ray, a spine with scoliosis looks more like an “S” or a “C” than a straight line. Some of the bones in a scoliotic spine also may have rotated slightly, making the person’s waist or shoulders appear uneven.

Scoliosis affects approximately 20 million people in North America, about 2 percent of the population, including children and adults. The condition tends to run in families. If someone in a family has scoliosis, the likelihood of another family member having it is much higher — about 20 percent.

As the population ages, adult degenerative scoliosis is becoming more common, with the condition typically developing at between age 50 to 70. The condition can have devastating effects on a person’s life in later years.

Treatment in this older population presents particular challenges due to other back conditions, such as osteoporosis. But significant advances — including minimally invasive surgery, new neuro-monitoring techniques and 3-dimensional imaging — allows older patients to receive limited doses of anesthesia and benefit from quicker recovery.

Scoliosis may be divided into five types:

  • Congenital Scoliosis — Congenital means that a person is “born with” scoliosis. Congenital scoliosis is caused by an abnormality of one or more vertebrae where they fail to form properly. This can be seen on X-ray and directly in the operating room.
  • Idiopathic Scoliosis — This is the most common form of scoliosis. The name idiopathic means “the cause is unknown.” Those with this type of scoliosis are otherwise healthy and normal. The spine shows no abnormality of the bones themselves on X-rays or by looking at it directly in the operating room. Idiopathic scoliosis may involve pain, which is more common in adults with scoliosis.While the overall incidence is equal in females and males, progressive or severe idiopathic scoliosis is about six to seven times more frequent in females.
  • Neuromuscular Scoliosis — This type of scoliosis occurs in people who have a disease of the nervous system, such as cerebral palsy.
  • Postural Scoliosis — Also known as “hysterical scoliosis,” postural scoliosis may be a result of pain, as a patient tilts to relieve the pain. It can be reversed by relieving the pain or by having the patient lie flat. X-rays don’t show any abnormality of the vertebrae.
  • Syndromic Scoliosis — This type of scoliosis occurs in people with a syndrome, such as Marfan syndrome or one of the skeletal dysplasias such as achondroplasia.

Progressive, severe scoliosis can produce three major problems:

  • If the part of the spine in the chest, called the thoracic spine, curves more than 60 degrees, the volume of the chest can be reduced, potentially compromising the function of the heart and lungs. For example, the heart may have to work harder to pump the normal volume of blood or the affected individual may have shortness of breath.
  • Severe curvature of the lower half of the spine that connects the chest with the pelvis, known as the lumbar spine, may push the contents of the abdomen against the chest and interfere indirectly with heart and lung function. Curvature of the lumbar spine also may alter sitting balance and posture.
  • Severe curvature of either the thoracic (upper) or the lumbar (lower) spine, or both, eventually becomes visible to others. The resulting tilting and twisting of the back, shoulders and pelvis may produce an appearance that the individual finds unacceptable. If idiopathic scoliosis affects a girl around the time of puberty, when body image is developing hand-in-hand with self-esteem, the condition can pose significant psychological and emotional challenges.

Traditional medical management of scoliosis is determined by the severity of the curvature and skeletal maturity, which together help predict the likelihood of progression.

Conventional treatment options include:

  1. Observation
  2. Physical therapy
  3. Occupational Therapy
  4. Chiropractic
  5. Bracing
  6. Surgery


Spine deformities can cause debilitating pain and seriously impact function, self-image and overall quality of life.

Spine deformities include:

  • Ankylosing Spondylitis
  • Kyphosis
  • Scoliosis
  • Spondylolisthesis

Patients with complex spinal deformities may require:

  • Surgery
  • Rehabilitation
  • Pain control
  • Physical medicine
  • Bracing
  • Orthotics

Ankylosing Spondylitis

Ankylosing spondylitis is an inflammatory condition that involves the spine and skeleton of the head and trunk. The disorder causes inflammation and pain in joints in the spine, pelvis and other parts of the skeleton. In addition, parts of the spine, the sacroiliac joints where the hips join the lower back, or the hips may fuse, or grow, together.

The typical patient is a young male, aged 20–40. Men are affected more than women by a ratio about of 3:1. The disease usually takes a more painful course in men than women.

Symptoms include:

  • Pain
  • Stiffness, especially in the morning
  • Functional limitation

When the disorder affects the spine, it also may result in progressive deformity including curvature of the back, called kyphosis, and the inability to stand up straight.

No cure is known for ankylosing spondylitis, although treatments and medications are available to reduce symptoms and pain. Physical therapy and exercise, along with medication, are the most common forms of therapy.


Kyphosis describes the exaggerated curve of the spine that results in a rounded or hunched back. Kyphosis may develop for several reasons. Postural kyphosis in children and adolescents may be related to habit and posture rather than underlying spinal deformity. In contrast, structural kyphosis refers to a round-back posture that is not reversible by paying attention to your posture and making an effort to sit and stand up straight. In adolescents, structural kyphosis may be caused by initial spine development with a rounded shape that is made worse by further growth. In the elderly, compression fractures characteristically result in loss of height and kyphotic deformity.

Symptoms of kyphosis include:

  • Back pain
  • Difficulty standing with an upright posture
  • Early fatigue to the back and legs

Kyphosis causes a bowing of the back, seen as a slouching back, as well as breathing difficulties. Severe cases can cause great discomfort and even lead to death.

Treatments include:

  • Body braces
  • Physical therapy
  • Surgery (in severe cases)


Spondylolisthesis is a condition in which one vertebra slips forward on the one below it.

In children, spondylolisthesis may occur as the result of a birth defect that affects the back of the spine or be caused by stress fractures within the back part of the spine. Spondylolisthesis is the most common cause of low back pain in adolescent athletes. In older people, the most common cause is degeneration of the discs between the vertebrae. With aging, the discs lose moisture, dry out and flatten, bringing the bones on either side closer together to the point where one slips forward on the other.

Typical symptoms of spondylolisthesis include:

  • Pain across the lower back
  • Hamstring tightness
  • Cosmetic deformity
  • Radiculopathy
  • Abnormal gait

However, a person can have the condition and not have pain.

Most often, treatment for spondylolisthesis includes:

  • Physical therapy to strengthen the back muscles
  • Pain medication
  • Bed rest
  • Wearing a back brace or corset

Children and adolescents whose spines have slippage greater than 30 percent to 50 percent may be candidates for spinal fusion surgery. Children and adults who have persistent pain despite non-operative care also may be considered for surgery.

Surgery for spondylolisthesis may involve decompression of the nerve roots by removing bone and/or intervertebral disc material, followed by fusion of the vertebrae with or without bracing.

Tethered Spinal Cord Syndrome

Tethered spinal cord syndrome is a neurological disorder caused by tissue attachments that limit the movement of the spinal cord within the spinal column. These attachments cause an abnormal stretching of the spinal cord.

Tethered spinal cord syndrome appears to be the result of improper growth of the neural tube during fetal development, and is closely linked to spina bifida. Tethering may also develop after spinal cord injury and scar tissue can block the flow of fluids around the spinal cord. Fluid pressure may cause cysts to form in the spinal cord, a condition called syringomyelia. This can lead to additional loss of movement, feeling or the onset of pain or autonomic symptoms.

The course of the disorder is progressive. In children, symptoms may include:

  • Lesions on the lower back
  • Hairy patches on the lower back
  • Dimples on the lower back
  • Fatty tumors on the lower back
  • Foot and spinal deformities
  • Weakness in the legs
  • Low back pain
  • Scoliosis
  • Incontinence

Tethered spinal cord syndrome may go undiagnosed until adulthood, when sensory and motor problems and loss of bowel and bladder control emerge. This delayed presentation of symptoms is related to the degree of strain placed on the spinal cord over time.

With treatment, individuals with tethered spinal cord syndrome have a normal life expectancy. However, some neurological and motor impairments may not be fully correctable.

In children, early surgery is recommended to prevent further neurological deterioration. If surgery is not advisable, spinal cord nerve roots may be cut to relieve pain. In adults, surgery to free (detether) the spinal cord can reduce the size and further development of cysts in the cord and may restore some function or alleviate other symptoms. Other treatment is symptomatic and supportive.

Tarlov Cysts

Tarlov cysts are sacs filled with cerebrospinal fluid that most often affect nerve roots in the sacrum, the group of bones at the base of the spine.

Women are at much higher risk of developing these cysts than are men.

These cysts (also known as meningeal or perineural cysts) can compress nerve roots, causing:

  • Lower back pain
  • Sciatica – shock-like or burning pain in the lower back, buttocks, and down one leg to below the knee
  • Urinary incontinence
  • Headaches – due to changes in cerebrospinal fluid pressure
  • Constipation
  • Sexual dysfunction
  • Some loss of feeling or control of movement in the leg and/or foot

Pressure on the nerves next to the cysts can also cause pain and deterioration of surrounding bone.

Tarlov cysts can be diagnosed using magnetic resonance imaging (MRI); however, it is estimated that 70% of the cysts observed by MRI cause no symptoms. Tarlov cysts may become symptomatic following shock, trauma, or exertion that causes the buildup of cerebrospinal fluid. Some scientists believe the herpes simplex virus, which thrives in an alkaline environment, can also cause Tarlov cysts to become symptomatic.

Most Tarlov cysts do not cause pain, weakness, or nerve root compression. Acute and chronic pain may require changes in lifestyle. If left untreated, nerve root compression can cause permanent neurological damage.

Tarlov cysts may be drained and shunted to relieve pressure and pain, but relief is often only temporary and fluid build-up in the cysts will recur. Corticosteroid injections may also temporarily relieve pain. Other drugs may be prescribed to treat chronic pain and depression. Injecting the cysts with fibrin glue (a combination of naturally occurring substances based on the clotting factor in blood) may provide temporary relief of pain. Making the body less alkaline, through diet or supplements, may lessen symptoms. Microsurgical removal of the cyst may be an option in select individuals who do not respond to conservative treatments and who continue to experience pain or progressive neurological damage.

Tabes Dorsalis

Tabes dorsalis is a slow degeneration of the nerve cells and nerve fibers that carry sensory information to the brain. The degenerating nerves are in the dorsal columns of the spinal cord (the portion closest to the back of the body) and carry information that help maintain a person’s sense of position.

Tabes dorsalis is the result of an untreated syphilis infection.

The disease is more frequent in males than in females. Onset is commonly during mid-life. The incidence of tabes dorsalis is rising, in part due to co-associated HIV infection.

Symptoms may not appear for some decades after the initial infection and include:

  • Weakness
  • Diminished reflexes
  • Unsteady gait
  • Progressive degeneration of the joints
  • Loss of coordination
  • Episodes of intense pain and disturbed sensation
  • Personality changes
  • Dementia
  • Deafness
  • Visual impairment
  • Impaired response to light

If left untreated, tabes dorsalis can lead to paralysis, dementia, and blindness. Existing nerve damage cannot be reversed.

Penicillin, administered intravenously, is the treatment of choice. Associated pain can be treated with opiates, valproate, or carbamazepine. Patients may also require physical or rehabilitative therapy to deal with muscle wasting and weakness. Preventive treatment for those who come into sexual contact with an individual with tabes dorsalis is important.

Spinal Cord Injury

In North America, the incidence of spinal cord injury has been estimated to be about 40 cases (per 1 million people) per year or 12,000 cases per year.

One can have spine injury without being involved in some form of traumatic injury. Spinal cord injury can occur from many causes, including:

  • Trauma such as automobile crashes, falls, gunshots, diving accidents, war injuries, etc.
  • Tumor such as meningiomas, ependymomas, astrocytomas, and metastatic cancer.
  • Ischemia resulting from occlusion of spinal blood vessels, including dissecting aortic aneurysms, emboli, arteriosclerosis.
  • Developmental disorders, such as spina bifida, meningomyolcoele, and others.
  • Neurodegenerative diseases, such as Friedreich’s ataxia, spinocerebellar ataxia, and others.
  • Demyelinative diseases, such as Multiple Sclerosis.
  • Transverse myelitis, resulting from stroke, inflammation, or other causes.
  • Vascular malformations, such as arteriovenous malformation (AVM), dural arteriovenous fistula (AVF), spinal hemangioma, cavernous angioma and aneurysm.

A spinal cord injury usually begins with a sudden, traumatic blow to the spine that fractures or dislocates vertebrae. The damage begins at the moment of injury when displaced bone fragments, disc material, or ligaments bruise or tear into spinal cord tissue.

Most injuries to the spinal cord don’t completely sever it. Instead, an injury is more likely to cause fractures and compression of the vertebrae, which then crush and destroy the axons, extensions of nerve cells that carry signals up and down the spinal cord between the brain and the rest of the body. An injury to the spinal cord can damage a few, many, or almost all of these axons. Some injuries will allow almost complete recovery. Others will result in complete paralysis.

Spinal cord injuries are classified as either complete or incomplete. An incomplete injury means that the ability of the spinal cord to convey messages to or from the brain is not completely lost. People with incomplete injuries retain some motor or sensory function below the injury. A complete injury is indicated by a total lack of sensory and motor function below the level of injury. People who survive a spinal cord injury will most likely have medical complications such as chronic pain and bladder and bowel dysfunction, along with an increased susceptibility to respiratory and heart problems. Successful recovery depends upon how well these chronic conditions are handled day to day.

Respiratory complications are often an indication of the severity of spinal cord injury. About one-third of those with injury to the neck area will need help with breathing and require respiratory support.

Improved emergency care for people with spinal cord injuries and aggressive treatment and rehabilitation can minimize damage to the nervous system and even restore limited abilities. The steroid drug methylprednisolone appears to reduce the damage to nerve cells if it is given within the first 8 hours after injury. Rehabilitation programs combine physical therapies with skill-building activities and counseling to provide social and emotional support.

Spinal Cord Infarction

Spinal cord infarction is a stroke either within the spinal cord or the arteries that supply it.

It is caused by arteriosclerosis or a thickening or closing of the major arteries to the spinal cord. Frequently spinal cord infarction is caused by a specific form of arteriosclerosis called atheromatosis, in which a deposit or accumulation of lipid-containing matter forms within the arteries.

Spinal cord infarction is a relatively rare condition, affecting about 12 in 100,000 people in the population.

Symptoms, which generally appear within minutes or a few hours of the infarction, may include:

  • Intermittent sharp or burning back pain
  • Aching pain down through the legs
  • Weakness in the legs
  • Paralysis
  • Loss of deep tendon reflexes
  • Loss of pain and temperature sensation
  • Incontinence

Recovery depends upon how quickly treatment is received and how severely the body is compromised. Paralysis may persist for many weeks or be permanent. Most individuals have a good chance of recovery.

Treatment is symptomatic. Physical and occupational therapy may help individuals recover from weakness or paralysis. A catheter may be necessary for patients with urinary incontinence.