Condition · thoracic

Spinal Trauma (Fractures and injuries of the spine)

Injury to the spinal column — the bones, discs, ligaments, or spinal cord — as a result of a fall, road traffic accident, or other acute event. Ranges from stable vertebral fractures that heal with bracing to unstable injuries that need urgent surgical stabilisation.

What is spinal trauma?

Spinal trauma is any injury to the spinal column — the vertebrae themselves, the discs and ligaments that connect them, or the spinal cord and nerve roots that they protect — resulting from an acute event. The most common mechanisms in Mumbai are road traffic accidents, falls from height, and, in older adults, low-energy falls onto osteoporotic bone.

Injuries range widely in severity:

• Stable vertebral compression fractures — the bone is broken but the spinal column’s overall alignment and neurological function are preserved
• Burst fractures — the vertebral body shatters, sometimes displacing bone into the spinal canal
• Fracture-dislocations — high-energy injuries that disrupt the column’s stability and often involve the spinal cord
• Ligamentous injuries — the bones may look normal on X-ray but the soft tissues that hold them together are torn

How it presents

Immediate symptoms after a spine injury commonly include:

• Sudden, severe pain at the level of the injury
• Difficulty or reluctance to move
• Tenderness that a clinician can localise on palpation

The following symptoms suggest neurological involvement and warrant emergency care:

• Weakness or numbness in the arms or legs
• Loss of coordination or difficulty walking
• Loss of bladder or bowel control
• Numbness in the groin or inner thighs (saddle anaesthesia)

How it is diagnosed

The diagnostic sequence usually is:

1. Clinical assessment — mechanism of injury, symptoms, and a targeted neurological examination
2. X-rays — a first-pass look at bony alignment
3. CT scan — the definitive test for characterising a bony injury and assessing stability
4. MRI — used when there is suspected spinal cord involvement, ligamentous injury, or when the mechanism is high-energy even if X-rays look reassuring

Treatment options

The right treatment depends on the specific injury pattern and whether it is stable or unstable, whether the spinal cord is involved, and how the patient presents.

Non-surgical management is appropriate for many stable fractures. It typically involves:

• A period of pain control and rest
• A brace (thoracolumbar or cervical) for a defined period
• Gradual, guided return to activity
• Follow-up imaging to confirm healing

Surgical stabilisation is discussed for:

• Unstable fractures where the spinal column cannot reliably heal in correct alignment
• Injuries with neurological compromise where decompression of the spinal cord or nerves is needed
• Patients whose pain or deformity is not controlled by conservative measures
• Some osteoporotic compression fractures where vertebroplasty or kyphoplasty can restore height and control pain

The specific technique — percutaneous fixation, open reduction and instrumented fusion, decompression with fusion — is chosen based on the injury pattern.

What recovery looks like

Recovery from a spinal injury is a longer arc than most other orthopaedic conditions. Realistic timelines:

• Weeks 0–2: initial recovery from the injury or from surgery; pain gradually reduces; mobilisation begins
• Weeks 2–8: bracing (if used) continues; gradual return to daily activities under guidance
• Months 2–6: structured physiotherapy; progressive return to work, driving, and lifting depending on the case
• 6 months onward: follow-up imaging to confirm healing; discussion of higher-impact activity

Neurological recovery, when there is nerve involvement, follows its own timeline and depends heavily on the initial injury.