How can a thoracic and lumbar fracture occur without any injury?

This is the 4773rd article of Da Yi Xiao Hu

Thoracic and lumbar spine fractures are common diseases in orthopedics, and most patients have a clear history of trauma. However, some patients go to the hospital for treatment due to back pain or limb weakness, numbness and pain, and finally find that it is caused by thoracic and lumbar spine fractures, but they do not have a clear history of trauma. What is going on?

To understand this clearly, let’s first look at the symptoms of thoracic and lumbar fractures!

(1) Pain

It is the most common symptom of spinal fractures. It is often more obvious when moving the trunk or changing posture, so most patients cannot stand or walk. It can usually be relieved by bed rest. However, the pain is so severe that it is difficult to even turn over in bed.

(2) Restricted activities

Patients with spinal fractures generally experience significant limitation of movement, especially pain in the waist and back when turning over or standing up. Patients often lie in bed and dare not move. Even if they try to get up, their movements are slow and stiff, and they dare not make large movements.

(3) Hunchback (kyphosis) and shortening of height

Not every fractured patient will have visible back deformity. Only when the fracture is severe or multiple fractures occur will hunchback deformity be seen. In addition, because the vertebral height becomes lower during a fracture, height may also decrease.

(4) Neurological symptoms

If the fractured bone protrudes into the spinal canal and compresses the nerves and spinal cord, corresponding neurological symptoms may occur. If the cervical and thoracic vertebral fracture compresses the spinal cord, paralysis symptoms such as incontinence, decreased sensation and motor function below the injury level may occur. Lumbar fractures may cause lower limb neurological symptoms, such as pain and numbness in the lower limbs.

If the above symptoms occur after trauma, you should go to the hospital in time to see a doctor to determine whether you have a thoracic or lumbar fracture. However, if you have not suffered obvious trauma but still have the above symptoms, you should be more vigilant because it may be a "pathological fracture."

"Pathological fracture" refers to a fracture of the diseased vertebra without obvious trauma or slight external force due to some kind of bone disease. Common pathological fractures of the spine include: 1. Osteoporotic vertebral fractures, 2. Fractures caused by vertebral tumors, and 3. Fractures caused by vertebral infection.

1. Osteoporotic vertebral fracture

The most common type refers to fractures that occur in daily life without obvious external force or "external force that does not usually cause fractures" on the basis of osteoporosis, such as falling on flat ground, carrying heavy objects, or even coughing. It usually occurs in elderly patients, especially postmenopausal women. For high-risk patients, bone density tests should be performed regularly, and if osteoporosis is found, drug intervention is required. For osteoporosis patients or high-risk groups, if severe low back pain or falls occur, they should seek medical attention in time to avoid missed fractures and greater harm.

The arrow points to osteoporotic vertebral fracture

2. Fractures caused by vertebral tumors

The spine is a favorite site for many tumors to metastasize to the bone. When a fracture occurs after a tumor metastasizes to the spine, the pain is generally more severe than that of an ordinary osteoporotic fracture, and it may even cause restlessness and insomnia. The probability of spinal cord and nerve compression is also higher. Therefore, if a patient with a history of tumors or a patient who is not yet at the age of osteoporosis has the above-mentioned symptoms of spinal fracture, he or she must go to the hospital for examination as soon as possible.

The arrow points to a thoracic vertebral tumor with pathological fracture and spinal cord compression.

3. Fractures caused by vertebral infection

It is relatively rare, and the symptoms caused by different pathogens may be slightly different. For some people, the history of infection can be traced back to other parts of the body, such as lung infection, skin infection, gastrointestinal infection, etc. Some patients have a history of fever.

The arrow points to the pathological fracture of the vertebra caused by thoracic tuberculosis

Therefore, if you experience symptoms of spinal fracture without being injured, or if the pain suddenly worsens on top of your existing back pain, you must go to the hospital for examination as soon as possible to identify the cause and start targeted treatment.

Author: Li Juan, Lin Hong

Instructor: Dong Jian

Unit: Shanghai Geriatrics Center (Zhongshan Hospital Minhang Meilong Branch)

Zhongshan Hospital Affiliated to Fudan University

Institute of Medical Science Popularization, Fudan University