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Burst Fracture: Causes, Symptoms & Treatment

A burst fracture is a severe vertebral body fracture in which the bone shatters into multiple fragments due to axial compression. It can endanger the spinal cord.

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Things worth knowing about "Burst fracture"

A burst fracture is a severe vertebral body fracture in which the bone shatters into multiple fragments due to axial compression. It can endanger the spinal cord.

What is a Burst Fracture?

A burst fracture is one of the most severe types of spinal fractures. It occurs when a vertebral body is subjected to a sudden, powerful axial force – meaning a force directed along the axis of the spine – causing it to shatter in multiple directions. Unlike a simple compression fracture, where only the front of the vertebral body collapses, a burst fracture involves the entire vertebral body breaking apart. Bone fragments can be driven into the spinal canal, potentially compressing or injuring the spinal cord or nerve roots.

Causes

Burst fractures typically result from high-energy trauma applied to the spine. Common causes include:

Falls from significant height (e.g., workplace or sports accidents)
Motor vehicle accidents (impact against the steering wheel or seat)
Diving accidents (head striking the pool or seabed)
Direct, forceful blows to the spine
In elderly patients or those with osteoporosis, even lower-energy forces may be sufficient to cause a burst fracture

The most commonly affected region is the thoracolumbar junction (approximately T12 to L2), as this transitional area is particularly vulnerable to axial loads.

Symptoms

Symptoms of a burst fracture vary depending on the severity and whether neural structures are involved:

Severe, localized back pain at the fracture site
Restricted spinal movement and stiffness
Numbness, tingling, or weakness in the arms or legs (if nerves are affected)
Neurological deficits such as partial or complete paralysis of the limbs
In severe cases: complete spinal cord injury with paralysis below the level of the fracture
Bowel and bladder dysfunction (with significant spinal cord involvement)

Diagnosis

Diagnosis of a burst fracture relies on imaging studies and clinical assessment:

X-ray: Initial evaluation, can reveal vertebral collapse, but may underestimate the extent of the injury.
Computed Tomography (CT): The gold standard for assessing fracture morphology, fragment displacement, and canal compromise.
Magnetic Resonance Imaging (MRI): Essential for evaluating the spinal cord, nerve roots, intervertebral discs, and posterior ligamentous complex.
Neurological examination: Assesses the presence and extent of sensory or motor deficits.

Classification systems such as the AO Spine Classification and the TLICS (Thoracolumbar Injury Classification and Severity Score) are used to guide treatment decisions.

Treatment

Conservative Treatment

Stable burst fractures without neurological deficits may be managed non-operatively:

Immobilization using a spinal orthosis or brace for several weeks
Pain management with analgesic medications
Physiotherapy to restore strength and mobility
Regular radiological follow-up to monitor fracture healing and stability

Surgical Treatment

Unstable fractures, progressive neurological deficits, or significant canal compromise typically require surgery:

Decompression: Removal of bone fragments from the spinal canal to relieve pressure on the spinal cord
Stabilization: Fixation of the affected vertebrae using screws, rods, or plates (spinal fusion/spondylodesis)
Vertebral body replacement: In cases of severe destruction, a titanium cage or bone graft may be used to restore vertebral height
Minimally invasive surgical techniques are increasingly employed

Rehabilitation and Prognosis

Recovery from a burst fracture requires comprehensive rehabilitation, including intensive physiotherapy, occupational therapy, and, where spinal cord injury is present, specialized neurological rehabilitation. The prognosis depends largely on the degree of neurological involvement. With timely and appropriate treatment, many patients achieve substantial functional recovery. However, severe spinal cord damage may result in permanent disability.

References

Vaccaro AR et al. - A New Classification of Thoracolumbar Injuries: The Importance of Injury Morphology, the Integrity of the Posterior Ligamentous Complex, and Neurologic Status. Spine, 2005.
Magerl F et al. - A comprehensive classification of thoracic and lumbar injuries. European Spine Journal, 1994.
Fehlings MG et al. - Spine Trauma Study Group: Evaluation and Treatment of Patients with Thoracolumbar Spine Trauma. Global Spine Journal, 2017.

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