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Typical examples of a frequent fracture are the femur or humerus.

When a fracture affects one or more vertebrae, i.e. the bones that make up our spinal column, it is called a ‘vertebral fracture’.

All vertebrae can be affected by a fracture, so – depending on the affected area – we will have a fracture in the cervical, thoracic, lumbar, sacral and coccygeal vertebrae.

Depending on the cause, the vertebrae may fracture more or less severely and – above all – may undermine the integrity of the spinal nerves and the spinal cord: in the latter case, the vertebral fracture becomes an extremely frightening event, as it may lead to permanent motor and/or sensory neurological deficits (e.g. paralysis) and, in the most serious cases, even the death of the patient.

A vertebral fracture can be related to myelopathy (bone marrow disease), radiculopathy (spinal nerve root disease) and/or discopathy (intervertebral disc disease).

Vertebral fractures are the subject of numerous classifications, although currently the Denis and AO classifications are mainly used.

Denis divided the vertebra into three columns: anterior (vertebral body), middle (pedicles) and posterior (laminae, articular processes and spinous) with their ligaments.

According to Denis’s classification there are minor fractures, which affect the transverse and spinous processes, the laminae and the joint isthmus, and major ones:

The OA classification divides thoracolumbar fractures into type A (compression), type B (flexion-distraction) and type C (type B + rotational component).

This classification has further categories based on various parameters, but basically the same considerations as those discussed in Denis’ system apply.

Vertebral fractures can be of two main types:

The following are at greater risk of vertebral fracture

Vertebral fractures due to osteoporosis often recur, especially if the patient does not manage the bone-weakening condition.

A vertebral fracture is responsible for back pain.

Sometimes moderate, sometimes intense (depending on the extent of the fracture), this pain has the particularity of worsening with movement.

If the vertebral fracture is accompanied by an injury to the spinal cord and/or spinal nerves, the symptom picture will be enriched by neurological disorders, such as

It should also be noted that, in the case of vertebral fractures close to the head, the energy of the injury may spread to the brain and cause loss of consciousness.

One of the major risks of a vertebral fracture is damage to spinal nerves and bone marrow, which can lead to partial or total, temporary or permanent paralysis of different parts of the body depending on the site of the injury.

Below is a schematic of the possible extent of paralysis (in blue) depending on the specific site of injury.

Generally speaking, we can say that the “higher” the spinal cord damage, the more extensive the possible paralysis.

Generally speaking, the following are essential for formulating the diagnosis of a vertebral fracture

It should be noted that, when the vertebral fracture is the result of trauma that may have damaged the spinal cord, the doctor has a duty to establish the patient’s vital signs before any further assessment of the extent of the injury; carried out in an emergency, this approach protects the patient from any manoeuvres that could make the situation worse.

The treatment of a vertebral fracture depends essentially on the type of fracture.

In general, the treatment approach is conservative in cases of mild and stable vertebral fractures, and surgical in cases of severe and unstable vertebral fractures.

At the end of the therapy aimed at repairing a vertebral fracture, a cycle of rehabilitation treatment (physiotherapy) always follows.

Conservative treatment of vertebral fractures involves the use of an orthopaedic back brace (orthosis) to keep the spine immobile and aligned during the bone healing process, and then, once the bone repair process is complete, includes a course of rehabilitation treatment (physiotherapy).

Conservative treatment is usually used in the case of:

It should be noted, however, that conservative therapy may also be used in the case of slight vertebral flexion/distraction fractures (fractures in which the injury is confined to the vertebral body).

The surgical treatment of vertebral fractures includes delicate vertebral fusion operations (in which the doctor uses screws, hooks, etc.), vertebroplasty or kyphoplasty, the aim of which is to restore the anatomy of the damaged vertebra or vertebrae and relieve any pressure on the spinal cord or neighbouring spinal nerves; as with conservative therapy, the surgical treatment of vertebral fractures also includes a course of rehabilitation.

As a rule, surgical treatment is used in the case of:

Readers are reminded that, unfortunately, spinal cord injuries are permanent, which means that there is no medical or surgical therapy to repair them.

After a spinal fracture, physical rehabilitation (or physiotherapy) is used to restore the elasticity and muscle tone of the back that existed before the injury.

The duration of physiotherapy varies depending on the type of vertebral fracture.

The treatment of vertebral fractures forces the patient to rest in bed; the resulting immobility is a dangerous factor in promoting the phenomenon of venous thrombosis along the limbs, especially the lower ones.

In addition to this dangerous complication, there are also possible complications that may arise from the use of surgery and which characterise this therapeutic option, regardless of the field of application (such complications consist of infections, haemorrhages, etc.).

Generally speaking, the more severe a vertebral fracture is, the less chance there is of a complete recovery; even, in the case of vertebral fractures associated with spinal cord injury, the restoration of certain motor functions (including control of the kidney and bladder sphincters) is impossible.

In the case of a vertebral fracture, bone repair times are between 6 and 12 weeks.

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