The management of spinal trauma has advanced significantly over the last few years. More rapid retrieval of patients has meant more survivors of major accidents. These patients are often best managed with early or emergency spinal stabilization to avoid later complications. 

By using advanced techniques the surgeons are able to provide early stabilization of the spine with decompression of the spinal cord and nerve roots.

Causes of fractures

One of the most common causes of spinal fractures is injury from horse-riding accidents and other sports injuries. In horse-riding accidents the rider is often flung from the horse and lands on the ground heavily. The effect of a fall where sharp impact on the ground is transferred into the spinal column can cause fractures of the vertebral bodies. The severity of the fracture depends on the force of impact as well as the angle of the fall. This is type of injury is treated as an emergency and the rider should be taken to hospital by ambulance.

Diagnosing a fracture

In many cases an experienced consultant spinal surgeon can determine whether a fracture has occurred however it is best practice to arrange an x-ray of the spine in order to be sure. The following images are x-rays taken after a fall as a result of a horse-riding accident before treatment.  [images to be inserted]

The damage caused by the accident to the vertebral body is clear and this type of injury requires surgery including fusion in order to ensure stability of the spinal column and to relieve the painful symptoms associated with this traumatic injury.

Treatment

Once diagnosed the long-term prognosis will benefit from early stabilisation and so surgery should be scheduled at the earliest possible time. It is not always treated as an emergency because bedrest can alleviate symptoms effectively. Surgery for spinal fractures is carried out under general anaesthetic. 

Normally in surgery a posterior (through the back) incision is made at the appropriate level to access the lumbar spine (lower part of the back). From this position the surgeon will remove any loose bodies or fragments of the fractured vertebra. Depending on the extent of the damage to the vertebral body it may be removed entirely, but this is not always the case. Once the operating field is cleared of debris the surgeon will use specialist instruments, bone graft (normally taken from a patient's rib) and implants to provide stability.

The implants are comprised of screws, rods and plates all made from titanium and are for stability and allow the bone graft to 'fuse' vertebrae together. The implants and grafting will usually span the fractured vertebra. If more than one level is affected the surgery is still possible but takes longer and becomes more complex the more fractured vertebrae there are.

The images below show the same aspects of the spinal column as shown above however they show the same patient's spine following surgery. [images to be inserted]

As you can see from the images the implants span the affected vertebral body by being attached to the adjacent healthy bodies. Occasionally where the damange to the vertebral body is more severe and the whole body needs to be removed the surgeon will use a device, usually made from titanium, which can be inserted in the space left by the resected vertebra. The device can both enhance stability and alignment and maintain appropriate disc height.

After surgery

Aftercare following surgery for spinal trauma can be found in the fusion section.

The x-ray below is an example of when this type of device is used. [image to be inserted]

Advances in technology

With advances in technology many of these devices are now able to stimulate bone growth around the implant over time for enhanced stability. There are new techonologies being developed as alternatives to spinal fusion to preserve maximum flexibilty and motion of the spine following surgery. Options such as disc replacement are already available but they are not used on a widespread basis as the advantage over spinal fusion has yet to be well established with robust clinical evidence. Implant design and enhanced sugical techniques however continue to progress in a way that allows surgeons to achieve better results, lower the risks of complications and reduce the trauma caused by the operation itself by being able to carry out the operation through a smaller incision.

For any enquiries please contact Mrs Mandy O'Sullivan who will endeavour to help you in any way possible.