Have you been diagnosed with a thoracic-lumbar fracture and looking for a simple yet comprehensive guide on the treatment options available and recovery timeline.
You are at the right place, for this article as usual I will rely on my experience as a diagnostic radiographer and research into medical published studies.
Happy reading!😀
Have any questions, remarks, or experience to share? Feel free to use the comments section at the end of the article!🙏
Last updated: Oct 2024. Written by Juliet Semakula, diagnostic radiographer.
Disclaimer: no affiliate links.
▶️What are different types of vertebral bodies?
Basic anatomy:
The vertebral column supports the body’s physical structure and nervous system, enabling movement and sensation.
We have 33 vertebrae that include:
♦️7 Cervical: Spine fracture: Broken vertebrae in your neck.
♦️12 Thoracic: Broken vertebrae in your upper back that runs from the bottom of your neck to the bottom of your ribs.
♦️ 5 Lumbar: Broken vertebrae in your lower back.
️ ♦️5 Sacral and coccygeal.
Image showing the different parts of the 33 vertebrae bodies of the spine
All these vertebrae can break as one or multiple and they are all called vertebral fractures.
▶️What are different types of vertebrae fractures?
Vertebral fractures are classified based on their location in the back(cervical ,thoracic and lumbar) and how precisely they are broken, the shape, number of pieces and the surrounding tissues.
Here are the main types of vertebral fractures.
🟢Burst fracture occurs when both the anterior and posterior sides of the vertebra break
🟢Wedge fracture is a subtype of compression fracture. Here, part of the vertebra usually the front part collapses under pressure and becomes wedge
🟢Vertebral compression fracture is a collapse of a vertebra.
🟢Chance (flexion distraction) fracture is a type of vertebral fracture that results from excessive flexion of the spine.
🟢Complete fracture happens when the front part of the vertebrae breaks but the back part does not.
🟢Dislocation or avulsion spine fracture occurs when bone and ligaments break.
🟢Pathological fracture occurs due to underlying bone disease like cancer or a condition affecting bone strength.
For this article I will only cover thoracic and lumbar spine fracture. You can check out articles on cervical (neck) and osteoporotic vertebral fractures.
▶️What are the symptoms you may have when you have fractured your back?
Most of the time when you have had a spine fracture you may not notice or have any symptoms.
Even when your spine has been affected by trauma like a fall or accident you may not experience a specific symptom from the fracture itself especially if you receive emergency treatment.
If you do experience symptoms they will include:
🔴 Back pain: you may feel a sharp intense pain in your back, it might also get increasingly worse over time, especially when you’re walking or moving.
🔴Swelling or tenderness: The area around the broken vertebrae may be swollen and painful to touch.
🔴 Changes to your posture: A new slump in your spine that causes you to lean forward in ways you didn’t before.
🔴Tingling or numbness: you may feel a tingling or numb feeling in your back that might run down your arms or legs.
🔴 Height loss: You might get noticeably shorter over time sometimes up to 6 inches.
🔴 Incontinence: A new loss of your ability to control your bladder or bowels.
▶️Diagnosis of spine fractures:
♦️ Not until you have had an x-ray to confirm the type of fracture you have and how displaced it is.
♦️CT scan will be needed if your fracture needs surgery to assess how damaged your bones are.
♦️MRI scan will give your doctor a complete picture of your back and any damage surrounding the spine.
You will be given a diagnosis after examination and x-ray about what kind of fracture you have got and what treatment options available.
▶️How are spine fractures managed or treated?
How your fractured spine is treated will depend on:
♦️What caused the fracture.
♦️Which type of fracture it is.
♦️Where in your back the broken vertebrae are.
Most nondisplaced spine fractures I have seen do not require surgery, management and treatment is usually by conservative methods such as:
⚪ Bracing
You may be given a brace to wear to help support your spine in alignment and help with the healing of the broken vertebrae.
⚪Physical therapy
You may need physiotherapy to help with exercises to strengthen the muscles of your back.
⚪Medication
You may be given pain medication such as (NSAIDs) to help reduce pain as you go through the healing process. Make sure you have a prescription from your doctor.
If your fractures are due to osteoporosis, you may be given osteoporosis medications such as calcitonin salmon and calcium supplements to help reduce pain, risk of future fractures and support your bone overall health.
⚪Surgery
If you have had a fracture because of trauma and after assessment it is in danger of damaging your spinal cord you may need surgery.
Or if you have pain that is not improving after treating you with the conservative method.
The most common type of surgeries to repair spine vertebrae fractures are vertebroplasty and kyphoplasty.
Surgery option with screws and plates.
Considering the wide range of risks and potential complications associated with spine surgery, it’s vital to consider alternative treatment methods that can provide relief without such risks.
The Non-Surgical Spinal Decompression Treatment is one such treatment method that has proven to be highly successful
▶️What is the healing and recovery time of a T-spine and Lumbar spine fracture
What do we understand by the term healing and recovery?
Healing more specifically implies physical healing of cells and tissues. Recovery is more focused on a return to normal function to your former state.
Both thoracic and lumbar spine healing will be quicker if the spinal fracture did not damage your spinal cord, nerves or tissue around your spine and when you have not had surgery.
Consolidation process begins within the first days following the fracture spontaneously with you doing anything.
You will have a follow-up x-ray to check the progress of the healing process which in most cases consolidation should be around 4 to 8 weeks after the fracture.
For some reassurance many spinal fractures heal around 3 months if you do not need surgery, it might take as long as 6 to 12 weeks to recover from surgery.
Here are some typical recovery timelines after a thoracic or lumbar vertebral fracture.
These timelines are based on my acquiring from spine surgeons and international scientific publications.
| Typical timelines | Duration |
| Your fracture sight begins to consolidate/heal | 6 to 8 weeks |
| You start feeling less pain | Days to a few weeks |
| Use crutches or a walker to walk | Immediately or after 2 months if walking was restricted. |
| Walking without assistance | A few weeks to months |
| You have fully recovered, gained muscle strength | 3 months at best, sometimes up to 1 year in some people. |
| Going back into sports it is advised you should be pain free, have full range of motion, full strength, and no evidence of neurologic injury | 3 months before returning to training,2 years before returning to competitive level sports (Huang 2016) |
▶️Does undergoing surgery impact the healing duration?
Yes, having surgery for a broken vertebra can impact the healing process and timeline.
Here are some of the reasons why surgery can influence the healing duration after a vertebral fracture:
1️⃣Stabilisation
Minimally invasive fixation using screws and plates are used to stabilise thoracic lumbar fractures and help reduce pain and allow early mobilisation.
So the recovery period can be extended because the body needs time to heal around the plates and sometimes screws can loosen and migrate.
2️⃣Risk of complications. With every surgery there are usually risks and complications such as blood clots, infection and delayed wound healing. The spine surgery involves manipulating the nerves in the spine, which can result in nerve damage.
This can cause numbness, weakness, or even paralysis. Which will all need time to heal.
3️⃣Type of fracture: when your fracture is complex, you may need surgery and healing will take time.
4️⃣Individual response to surgery is different, some people may recover more quickly than others based on factors like age, overall health and genetic predisposition to healing well.
▶️How long should you wear a brace after a broken vertebra?
A spinal brace is a device designed to limit movement of the spine. Not all people who have a spinal fracture need to wear a spinal brace.
This decision will be made on an individual basis based on the type of fracture you have, the location of the fracture and any other medical problems or injuries.
Limiting the movement of the spine through wearing a spinal brace helps the healing process. It may also help to prevent further injury or damage and can help to minimise discomfort.
Your consultant should have explained the reason for having to wear your spinal brace and you may need help from your physiotherapy to show you how to wear it properly.
If you do need to wear a brace whether you have had surgery or not it is usually worn for about 3 to 4 weeks, often 8 weeks or longer usually after a follow up x-ray or scan.
You will be advised to wean from your spinal brace gradually to prevent sudden strain on your back and to help to strengthen your spinal muscles slowly to minimise discomfort.
Your physiotherapist will advise you on this, recommending you decrease the time spent in the spinal brace daily over 1-2 weeks.
Some individuals are tempted to use a soft lumbar belt instead of a brace. While these belts can alleviate pain, they don’t provide the same level of fracture stabilisation.
However, if the brace causes significant discomfort, you can always discuss its necessity with your physical therapist or doctor and you will be given an alternative.
▶️How long should you abstain from walking after a broken vertebra?
Except in specific cases, walking is often permitted after a vertebral fracture!
How long you should abstain from walking will depend on the type of fracture you have, your medical history, health status, preferences, and priorities.
If after seeing a specialist and you are given approval, YES, you can walk with a broken vertebra, because remaining entirely inactive until the fracture has healed can be counterproductive.
Initially after your hospital admission, your back may be sore as you move; this may increase over the first couple of days but will then improve.
Sometimes bed rest will be recommended for a few days after you have a thoracolumbar back fracture.
Walking is a great way to maintain your activity and fitness levels whilst you recover from your spinal fracture.
You should aim to walk short distances little and often to ensure your muscles do not stiffen up. Once you are home, try to increase the distance you walk daily, always paying attention to your posture.
It is important to strike a balance between periods of activity and inactivity. Inactivity can be just as harmful to your back as over activity.
We have come to the end of this article, wishing you a quick recovery!🙋
📚Sources:
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Huang P, Anissipour A, McGee W, Lemak L. Return-to-Play Recommendations After Cervical, Thoracic, and Lumbar Spine Injuries: A Comprehensive Review. Sports Health. 2016 Jan-Feb;8(1):19-25. doi: 10.1177/1941738115610753. Epub 2015 Oct 14. PMID: 26502187; PMCID: PMC4702157.
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Mazel C, Ajavon L. Malunion of post-traumatic thoracolumbar fractures. Orthop Traumatol Surg Res. 2018 Feb;104(1S):S55-S62. doi: 10.1016/j.otsr.2017.04.018. Epub 2017 Nov 27. PMID: 29191468.
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