Lumbar Trauma/Fractures

In the case of trauma, dislocations and fractures can result in an unstable spinal column. They can occur in any region of the spine and may be associated with neurological injury.

Symptoms

Severe lower back pain. There may also be radicular symptoms with pain, numbness, or weakness extending into the legs. If severe, loss of coordination and bowel or bladder incontinence may occur.

About this Condition

Trauma to the spine refers to injury that has occurred to bony elements, soft tissues and/or neurological structures. The two things that surgeons are most concerned about, in the case of spinal trauma, are instability of the vertebral column and actual or potential neurological injury. Stability to the spinal column can be compromised when bony elements are injured or there is disruption to soft tissues such as ligaments. Instability causes the spine to become unable to successfully carry normal loads, which can lead to permanent deformity, severe pain and in some cases catastrophic neurological injuries. Most often the instability comes from a fracture in one of the bony parts of the vertebra, specifically the vertebral body, the lamina or the pedicles.

In the case of trauma, dislocations and fractures can result in an unstable spinal column. They can occur in any region of the spine and may be associated with neurological injury. A surgeon needs to restore the mechanical stability of the spine to try and prevent more neurologic injury, progressive deformity or prolonged incapacitating pain.

The most common types of fractures affecting the low back are compression fractures which usually result from a fall.

Ligamentous Injuries: Many things can happen to a ligament upon injury. The ligament can be strained or sprained or it can tear or it can break all together. Treatments for these different types of injuries are different.

Musculoskeletal Injuries: Back pain is most likely to occur when the muscles in the back are not up to the task of protecting the spine. This can happen because a person is out of shape, fatigued or when they subject their back to sudden forces or heavy loads.

This content is for your general education only. See your doctor for a professional diagnosis and to discuss an appropriate treatment plan.

Conservative Treatments

Physical Therapy / Occupational Therapy

Physical and occupational therapy can play a vital role in your recovery. Once acute pain improves, your doctor or a therapist can design a rehabilitation program to help prevent recurrent injuries.

These programs often include heat, cold and electrotherapy to help alleviate pain, decrease swelling, increase strength and promote healing. Methods include therapeutic exercise, manual therapy, functional training and use of assistive devices and adaptive equipment to increase strength, range of motion, endurance, wound healing and functional independence.

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Surgery

Posterior Fusion

Following a discectomy, laminectomy or other surgery that involves removing portions of one or more vertebrae to relieve pressure on the spinal cord and nerves, fusion instrumentation and bone grafting are used to stabilize the spine. Metal or non-metal instrumentation is put in place to hold the vertebrae together as the bone graft grows and fuses the vertebrae. These implants include rods, plates and screws that are left in place after the surgery. Bone grafts may be placed on the outside of the two vertebrae or between the vertebrae (interbody).

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Anterior Fusion

Anterior lumbar interbody fusion (ALIF) is a spine surgery that involves approaching the spine from the front (anterior) of the body to remove all or part of a disc from in between two adjacent vertebrae (interbody) in the lower back (lumbar spine), then fusing, or joining together, the vertebrae on either side of the remaining disc space using bone graft or bone graft substitute.
The graft material acts as a binding medium and also helps maintain normal disc height – as the body heals, the vertebral bone and bone graft eventually grow together and stabilize the spine. Instrumentation, such as rods, screws, plates, cages, hooks and wire also may be used to create an “internal cast” to support the vertebral structure during the healing process.

Depending on your condition and your surgeon’s training, experience and preferred methodology, an ALIF may be done alone or in conjunction with another spinal fusion approach. Please discuss your fusion approach options thoroughly with your doctor to learn which is most appropriate for your particular condition.

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[Source: Medtronic]

Transforaminal Lumbar Interbody Fusion (TLIF)

A transforaminal interbody fusion (TLIF) is a technique where the disc is removed from the posterior approach. The bony endplates are scraped until rough and the space is filled with a plastic or metal cage and bone chipes to achieve a fusion between the vertebral bodies.

When combined with a posterior fusion, this provides 360° spinal stability without the need for a second anterior incision.

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Please keep in mind that all treatments and outcomes are specific to the individual patient. Results may vary. Complications, such as infection, blood loss, and bowel or bladder problems are some of the potential adverse risks of surgery. Please consult your physician for a complete list of indications, warnings, precautions, adverse events, clinical results and other important medical information.