How is the severity of lumbar fracture classified? What tests are needed?

Author: Tao Sheng, Chief Physician of the Eighth Medical Center of the General Hospital of the Chinese People's Liberation Army

Reviewer: Ren Dajiang, Chief Physician of the Seventh Medical Center of the General Hospital of the Chinese People's Liberation Army

Lumbar fractures are part of spinal fractures, and the incidence of lumbar fractures is relatively high. The common cause for young people is trauma, such as falling from heights and car accidents; the common cause for the elderly is osteoporosis, which is called brittle fractures. Lumbar vertebral fractures generally have a high healing rate. If they are not treated in time in the early stages, they will lead to abnormal healing.

The severity of lumbar fractures is divided into Type A, Type B, and Type C according to professional criteria, but for the general public, the more familiar terms are compression fractures, burst fractures, or displaced fractures. Simply put, a compression fracture often refers to a change in the height of the vertebral body; a compression fracture is a burst fracture when the vertebral body is crushed; and a displaced fracture is called a displaced fracture when the vertebral body is crushed and accompanied by anterior-posterior dislocation in the lateral position, left-right dislocation in the anteroposterior position, or even rotational dislocation.

Figure 1 Original copyright image, no permission to reprint

For the spine, simple compression fractures are much more stable than burst fractures, and the affected part is relatively small. If a burst fracture crushes one of the lumbar vertebrae, the force has been dispersed, and it is difficult to affect the adjacent vertebrae or the skipped vertebrae. In very rare cases, it will affect, that is, damage two or more vertebrae at the same time. From this point of view, in terms of severity, simple compression fractures are relatively mild, followed by burst fractures, and displaced fractures are the most serious.

It should be noted that if the spine is fractured or injured, extreme caution must be taken during transportation to avoid secondary spinal cord injury caused by improper transportation. Sometimes the spinal cord is not damaged originally, but incorrect transportation methods may cause spinal cord injury, which in turn leads to irreversible paralysis. For spinal injuries, special transportation methods must be used. For cervical fractures, the head must be fixed, and both hands are inserted from under the ears, dragging the cervical spine and using the head as a pillow for transportation; for spinal and thoracic fractures, rolling transportation is used, with three to four people standing on the same side of the patient, protecting the head, neck, chest, and waist respectively, and moving the patient in a coordinated manner. The hospital is equipped with special stretchers and flatbed cars for the safe transportation of such patients.

Figure 2 Original copyright image, no permission to reprint

What kind of examinations are generally required for lumbar fractures? When pain or trauma occurs in the lumbar spine, the doctor will first ask about the medical history, conduct a physical examination, identify the location of the pain, and then perform relevant imaging examinations. It should be emphasized that a physical examination must be performed, and it is not enough to simply look at the film to avoid missed diagnosis or misdiagnosis.

For violent injuries in young people, X-rays can basically confirm the diagnosis. Further CT scans are done to understand the type and details of the fracture, the specific site of injury, and the condition of vertebral fragmentation, to provide a basis for surgery. Magnetic resonance imaging is mainly used to understand whether the nerves, spinal cord, and soft tissues are damaged. If numbness or pain in the legs occurs, the nerves are considered to be damaged, which cannot be determined by CT scans and requires MRI scans. From a diagnostic point of view, X-rays are sufficient for violent injuries in young people. It is different for the elderly. Most of their fractures are caused by minor violence and there may be no obvious displacement. The vertebral compression height is generally around 1/3-1/4, and the vertebral height is reduced by 1/4-1/3. After lying flat, the vertebral height may naturally return to normal. It is difficult to find fractures on ordinary X-rays. At this time, MRI scans are needed and CT scans are not very meaningful.

Lumbar fractures cause the fracture site to be interrupted. The most obvious effect is that the lumbar spine loses continuity and stability. The main purpose of treatment is to restore the stability of the spine. Treatment methods generally include conservative treatment and surgical treatment. Surgical treatment mainly includes internal fixation, one of which is open surgery and the other is minimally invasive surgery, including vertebroplasty, percutaneous nail fixation, etc.