What is a thoracic fracture?
A thoracic fracture is an umbrella term covering all of the spinal fractures that can occur from the first thoracic vertebrae (upper back) and the twelfth thoracic vertebrae (mid-low back). Your Thoracic spine (mid/upper back) is made up of 12 connected bones called vertebrae. The vertebrae are connected to each other above and below through strong discs and joints on either side called facet joints. Your discs protect your spine by acting like shock absorbers to distribute weight through your back evenly. The facet joints on the other hand not only control but allow the movement of your back. Think of your facet joints like the steering mechanism of your spine it is their job to determine what movements can be made and the extent of those movements. The disc in the middle and the facet joints either side form what professionals refer to as the “three joint complex” that makes your spine a strong and durable structure. Your rib cage attaches to the thoracic spine providing it with support but also decreasing its range of movement making your thoracic spine stronger than the cervical (neck) or lumbar spine (low back).
Why & when does a thoracic fracture happen?
Due to the durable nature of your thoracic spine a substantial force is needed to cause a thoracic fracture. In most instances thoracic fractures are the result of high speed car accidents or severe falls where there is a direct blow or impact to the head and neck. Certain contact sports such as rugby, American football and non-contact sports such as skiing and horse riding carry a greater fractures injury risk. These types of fractures are commonly seen in the elderly as often their bones are weakened by osteoporosis. In cases of advanced osteoporosis fractures can happen as a result of normal daily activities and not as the result of any trauma.
What to do if a thoracic fracture is suspected after trauma?
After any severe accident or trauma a thoracic fracture is suspected until ruled out. When a thoracic fracture is suspected then the patient will be immobilised immediately with a neck brace and strapped onto a stretcher, this is to ensure no sudden movements are made as this could further damage the spine or spinal cord.
What does a thoracic fracture feel like?
There is normally an immediate onset of extreme pain after the injury occurs and will be accompanied by swelling and bruising. Any movement will cause severe sharp pain and at rest the pain levels will fluctuate between the severe sharp pains to an intense ache. This pain will rapidly spread from the back into the upper back, lower back and round into the sides. In some cases a nerve or portions of the spinal cord may be compressed or injured in this circumstance intense side or leg pain, pins & needles, weakness, sensation changes or bowel & bladder dysfunction may occur.
How will a thoracic fracture be diagnosed?
Patients will be taken A&E and a full neurological examination will be done including muscle strength, reflexes and skin sensation tests to rule out nerve or spinal cord injury. Your doctor will order an X-ray of the neck to confirm the diagnosis and identify the location of the fracture. If your doctor wants to assess the fracture further then a CT scan will be ordered as this will give a more detailed view of the fractured site. In cases where spinal cord or nerve damage is suspected an MRI will be ordered.
What treatment options are available for a thoracic fracture?
The patient will remain completely immobile until the doctor is satisfied that it is safe to move again. The doctor will most likely prescribe anti-inflammatory medication and painkillers for pain relief and to reduce any swelling. The Doctor will most likely provide you with a back brace or cast to help support the back as it heals. A fracture can take anything from 6 -12 weeks to heal. You will be referred through to a physiotherapist who will provide you with exercises to strengthen your back and may use traction to aid the healing process. In some cases surgery may be needed when the spine is found to be unstable or when there is compression on a nerve or the spinal cord.
There are 4 different types of Thoracic fracture;
A Compression Fracture is a fracture of the vertebral body where the front of the body is crushed but the back of the vertebrae stays intact forming a wedge shape. This is normally seen in elderly patients with conditions like osteoporosis. A compression fractures can cause a lot of back pain, but usually the pain is not nerve pain and the spinal cord is rarely affected.
A Burst Fracture is a compression fracture in which the entire spinal vertebra breaks. Crushing the front and back of the body. Unlike the compression fracture this is more likely to affect the nerve or spinal cord. It is most commonly caused by a fall from a great height and landing on the feet.
Isolated process fractures (spinous or transverse process fractures) this fracture most commonly results from rotation or extreme sideways bending, and usually does not affect the spines stability. Spinal cord and nerve complications are very rare from this fracture.
Fracture dislocations (see Spondylolisthesis ) This is a fracture of the pars interarticularis a piece of bone that prevents the vertebrae from slipping forward. This fracture is rare but can frequently cause serious spinal cord and nerve injury.