Fractured Spine Recovery in Elderly UK: Causes, Prevention and Treatments

What exactly is a spinal fracture? A spinal fracture refers simply to a ‘broken bone’ in the back. We often say that someone has ‘broken their back’ when we describe someone who has a spinal fracture following a traumatic accident.

Vertebral fractures, another term for spinal fractures often used in medical contexts, are common in individuals with osteoporosis but can affect anyone with a spinal injury.

There are 33 bones in our spine known as vertebrae that provide support to our bodies, allowing us to hold ourselves up, twist and bend over. Fracturing one or more of these bones can be demobilising and requires a lot of rest and specialist treatment – other times it’s not that serious.

In this article, the UK’s leading spinal surgeon, Mr Caspar Aylott, discusses the various causes of a spine fracture, how you can prevent it from happening and what the main forms of treatment are.

What are the types of spinal fractures?

There are many different types of spinal fractures and they all produce back pain.

Fractures may involve an important weight-bearing section of the spine or part of the bone which has muscles or ligaments attached.

Serious fractures are usually caused by a high-energy injury such as a road traffic accident, falling from a horse or height, extreme sports, etc. Specialists assess fractures to determine if they are stable or unstable. Unstable fractures may result in damage to the nerves or spinal cord leading to paralysis or even death.

What can cause a spinal fracture?

There are typically four main reasons for having a spine fracture:

• Insufficiency fractures – weak bones in the elderly. No trauma.
• Traumatic fractures – Strong bones in young. Violent trauma.
• Stress fractures – Strong bones in adolescence. Repetitive minor trauma.
• Pathological fractures – Weakened bone by cancer. No trauma.

Muscle spasms can occur due to changes in the shape of the spine following a fracture.

Diagnosing Spinal Fractures

Accurate diagnosis is crucial for effectively treating spinal fractures. The process typically begins with a thorough physical examination, where your doctor will assess your overall condition, check for tenderness or bruising, and evaluate your range of motion. They will also take a detailed medical history, asking about any previous injuries or conditions that might have contributed to the fracture.

To confirm the diagnosis and determine the severity of the fracture, your doctor may order imaging tests such as X-rays, CT scans, or MRI scans. These tests provide detailed images of the spine, helping to pinpoint the exact location and extent of the fracture. They also reveal any potential complications, such as nerve damage or spinal cord compression, which are critical for planning the appropriate treatment.

In some cases, additional tests like a bone density test may be necessary to assess your overall bone health. This is particularly important if there is a suspicion of osteoporosis, which can increase the risk of future fractures. By combining these diagnostic tools, your doctor can develop a comprehensive treatment plan tailored to your specific needs.

How can you prevent a spinal fracture?

Avoid accidents and extreme sports! BUT you can’t go through life ‘wrapped in cotton wool’ and accidents do happen!

The most common type of spinal fractures are not actually related to accidents but a weakness of the bones as we get older. This ‘thinning’ of the bones may be referred to as osteoporosis and is also the cause of wrist and hip fractures in the elderly.

This condition is more common in females following early menopause, but family history, long term steroids, etc. are important and we must not forget men can also suffer from this condition too. Therefore, diagnosing this condition early, before fractures happen, is really important. A good diet, regular exercise and medical treatments can really help to reduce fractures.

Additionally, maintaining good posture and using the correct technique during daily activities, especially when lifting objects, can prevent spinal fractures.

How do you treat spinal fractures?

Treatment depends on the type of fracture.

• Unstable fractures can move out of place (displace) when we stand, therefore most unstable spine fractures need surgery with strong metal screws and rods to hold the spine together allowing bone healing. Sometimes a patient may be confined to flat bed rest for several months allowing the fracture to heal or ‘set’. A neck or back brace may also be worn for three months. The typical healing timeframe for spinal fractures is around 12 weeks.
• Insufficiency fractures caused by osteoporosis are normally stable. Osteoporotic bone breaks more easily but heals normally. Fractures tend to heal over three months or longer with plenty of reclined rest. Cement can also be injected into insufficiency fractures to quickly improve pain and walking and help restore the normal shape of the bone. This is called balloon kyphoplasty. Conservative treatment is often used, allowing the bone to heal naturally.
• Stress fractures are a very specific type of fracture usually found in the lower back. They usually produce back pain in sporty teenagers, classically dancers, cricket bowlers, gymnasts, etc. Treatment usually requires several months of rest to give the fractured bone a chance to heal. Patients should avoid lifting heavy objects during the recovery period.
• Pathological fractures are usually caused by cancer (myeloma, breast, lung, prostate, kidney cancer, etc.) spreading into the spine and weakening the bone. Treatment usually involves drugs and/or radiotherapy to kill the cancer. Surgery may also be necessary if the spine fracture is unstable.

How long does it take to recover from a spinal fracture?

Recovering from a spinal fracture can be a lengthy process, often taking several weeks to several months, depending on the severity of the fracture and the effectiveness of the treatment. During this period, following a comprehensive recovery plan is essential to ensure proper healing and minimize the risk of complications.

Your doctor may recommend a combination of conservative treatments to manage your symptoms and promote healing. These can include pain management strategies, physical therapy to restore mobility and strength, and the use of a spinal brace to stabilize the fracture site and prevent movement. In some cases, surgery may be necessary to stabilize the spine and prevent further complications.

It’s crucial to adhere to your doctor’s instructions and attend all scheduled follow-up appointments to monitor your progress. Being vigilant about potential complications, such as infection, nerve damage, or spinal cord compression, is also important. If you experience any severe symptoms, seek medical attention immediately. With proper care and management, most spinal fractures can heal naturally, allowing you to resume your normal activities.

What is the Best Exercise for a Fractured Spine?

When recovering from a fractured spine, engaging in the right exercises is crucial to support the healing process and prevent further injury. The best exercises focus on gentle movements that enhance flexibility, strengthen the surrounding muscles, and improve overall stability without placing undue strain on the fracture site. Walking is often recommended as it promotes circulation and maintains cardiovascular fitness.

Additionally, water-based exercises like swimming or aqua therapy can be highly beneficial, as the buoyancy of water reduces pressure on the spine while allowing for a full range of motion. Under the guidance of a physiotherapist, specific exercises such as pelvic tilts, leg slides, and gentle core strengthening can help enhance muscle support around the spine. It’s essential to follow a tailored exercise plan that respects the limitations of your injury and gradually progresses in intensity as your recovery advances.

What are the complications and risks of a fracture?

While most spinal fractures can be managed conservatively, there are potential complications and risks associated with this condition. One of the primary concerns is nerve damage, which can result in numbness, tingling, or weakness in the affected area. In severe cases, spinal fractures can lead to spinal cord compression, causing paralysis or loss of bladder and bowel function.

Infection is another risk, particularly if the fracture is severe or if surgery is required. While antibiotics can treat most infections, severe cases may necessitate additional surgical intervention. Chronic pain is also a common issue, which can be managed with pain medication and physical therapy.

Spinal fractures can sometimes indicate underlying osteoporosis, a condition that weakens bones and increases the risk of future fractures. It’s essential to address this underlying issue to prevent further complications.

Being aware of these potential risks and seeking prompt medical attention if severe symptoms arise is crucial. With proper treatment and management, most people can make a full recovery from a spinal fracture and return to their normal activities.

Summary

It is important to remember that a simple X-ray taken by a doctor does not necessarily exclude a spine fracture. More advanced imaging may be necessary.Advanced imaging techniques such as CT scans and MRI scans are invaluable for accurately diagnosing spinal fractures. CT scans provide detailed cross-sectional images of the spine, allowing doctors to assess the extent of the fracture and any associated damage to the surrounding bones and tissues. MRI scans, on the other hand, offer a comprehensive view of the soft tissues, including muscles, ligaments, and nerves, which is crucial for identifying any potential complications such as nerve compression or spinal cord injury. Utilizing these imaging methods ensures a more precise diagnosis, facilitating the development of an effective treatment plan tailored to the patient’s specific

We can investigate your back pain properly and without delay and provide you with both an accurate diagnosis and the correct advice and treatment. The healing process involves a natural recovery of the bone over several months.

Mr Caspar Aylott is an expert consultant spinal surgeon practising at The London Spine Unit and Cheltenham Spine Clinic. To book a face-to-face appointment with him, or Video Consultation if you are unable to travel, book an appointment here.