Burst fracture

A burst fracture is a type of traumatic spinal injury in which a vertebra breaks from a high-energy axial load (e.g., traffic collisions or falls from a great height or high speed, and some kinds of seizures), with shards of vertebra penetrating surrounding tissues and sometimes the spinal canal. The burst fracture is categorized by the "severity of the deformity, the severity of (spinal) canal compromise, the degree of loss of vertebral body height, and the degree of neurologic deficit." Burst fractures are considered more severe than compression fractures because long-term neurological damage can follow. The neurologic deficits can reach their full extent immediately, or can progress for a prolonged time.

Diagnosis is by medical imaging.

A burst fracture of L4 as seen on plane X ray

A burst fracture of L4 as seen one plane X ray

A burst fracture of L4 as seen on CT

A burst fracture of L4 as seen on CT

A burst fracture of L4 as seen on CT

Immediate hospitalization is required, as such injuries may result in varying degrees of spinal cord injury with possible paralysis. X-rays and MRIs are taken to determine whether the burst fracture can be managed with or without surgery. Surgical management is required when the burst fracture is unstable. Predicting spinal instability of vertebral thoracic lumbar fractures is based on several radiologic and clinical parameters. Efforts to refine fracture classification schemes to better predict instability continue. Application of axial zone model proposed by physicians at Barrow Neurological Institute may enhance the ability to predict stability, depending not only on the number of columns, but also on the number of zones involved in the injuries. Further clinical and biomechanical studies are warranted to validate this model.

Different surgical treatments are available, the most common involving fusion of the remaining vertebra in the traumatized area, and removal of the larger loose vertebra pieces. A "spinal fusion" surgery entails two or more vertebra are permanently immobilized through surgery using titanium implants. Another less common technique is to replace the burst vertebra with an artificial bone or cadaver bone. Both latter strategies have been used successfully in elderly subjects, and has not yet been attempted in younger subjects due to the unknown stability over the long term.

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Wikipedia