Will a lumbar fracture damage the nerves? In what cases is surgery required?

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

The spine includes the cervical spine, thoracic spine, lumbar spine, sacral spine, and coccygeal spine. The most common fracture site is the lumbar spine. 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.

Figure 1 Original copyright image, no permission to reprint

There are several major causes of lumbar fractures: the most common is trauma, such as falling from a height, car accidents, etc.; the second is tumors, such as spinal metastatic cancer, tumor cells destroy normal bone, and very slight trauma can cause fractures; the third is infection, such as spinal tuberculosis, the tuberculosis bacteria erode the bone, causing bone destruction and prone to fractures; the fourth is osteoporosis, the fracture caused by osteoporosis is called brittle fracture, and very slight violence, such as a cough or a slight bump, can cause fractures.

The first symptom after a lumbar fracture is pain, which is most obvious when the body position changes; second, the movement is limited, and it is impossible to turn over or stand upright; third, lumbar fracture is a sudden event, and at the moment of fracture bursting, the broken bones fall into the spinal canal and nerve root canal, compressing the nerves, causing numbness, shooting pain, sensory impairment, and movement impairment in one or both legs. Some patients may even suffer from incontinence.

If you suspect a lumbar fracture, you should seek medical attention promptly. Imaging examinations can confirm the diagnosis. Treatment is divided into conservative treatment and surgical treatment.

Conservative treatment mainly consists of bed rest. When the fracture site has not healed, weight bearing should be avoided, as weight bearing will cause further compression of the vertebral body. Generally, the pain of lumbar fractures will basically go away after 2-3 weeks of bed rest. There will be no pain when sitting up or walking. Many patients start to bear weight without strictly following the key points of conservative treatment. After three months or six months, it is found that the lumbar spine has been compressed by half, which is worse than before. When conservative treatment is used for lumbar fractures, patients need to stay in bed for at least 6-8 weeks, during which they must remain in an absolute bed rest state. The upper body must not be upright and they must lie flat on the bed throughout the process, but turning over is allowed.

Figure 2 Original copyright image, no permission to reprint

Lumbar fracture is a natural healing process, and drugs have no fundamental effect on fracture healing. In the early stage, you may take some anti-inflammatory and analgesic drugs to relieve local pain. After the pain symptoms are significantly reduced in 7-10 days, you don't need to take painkillers anymore.

After 6-8 weeks of bed rest, if the doctor assesses that the patient can start walking, the patient must fully train the back muscles and wear a waist belt when walking. After walking, the back muscle training should also continue until the waist belt is removed, which usually takes 1-2 months.

There are generally two types of surgical methods, open surgery and minimally invasive surgery. Open surgery is generally fixed with nails and rods, or nails and rods combined with bone cement; minimally invasive surgery can use bone cement, or simple nails and rods for fixation, or nails and rods combined with bone cement, and there are also nail plates. Choose the appropriate surgical method according to the specific circumstances of the fracture. Under what circumstances does lumbar fracture require surgical treatment?

First, if the nerves and spinal cord are compressed and neurological symptoms occur, surgery is required. Second, for unstable lumbar fractures, such as burst fractures, surgical treatment is recommended. Third, for mild compression fractures, conservative treatment can be adopted, but at least two months of bed rest is required. Surgical treatment is also an option, and patients can choose according to their own conditions.

Doctors generally recommend surgical treatment for lumbar fractures caused by osteoporosis in the elderly. Evidence shows that the mortality rate of patients with lumbar fractures over 80 years old who are bedridden for more than two or three months can reach more than 30%, and the risk of complications caused by long-term bed rest is much greater than the risk of surgery. For the elderly, especially those with poor basic physical conditions, such as diabetes, heart disease, lung disease, etc., surgical treatment should be actively considered.