What it is
Spinal fractures from significant trauma — falls, vehicle collisions, sporting injuries — range from minor and stable to injuries that threaten the spinal cord. The central question is always stability: whether the spine can hold its alignment under normal load.
Dr. Long's fellowship was at a Level I trauma center, and spinal trauma is a core part of his practice.
Symptoms
- Severe back or neck pain following injury
- Pain on any attempt to move or bear weight
- Numbness, weakness or tingling in the arms or legs
- Loss of bladder or bowel control
Any of the last two after an injury is an emergency and belongs in an emergency department rather than a clinic.
How it is diagnosed
CT defines the bony injury and is the main investigation after trauma. MRI shows the ligaments, the discs and the spinal cord, which is what distinguishes a stable fracture from one that only looks stable on CT. Standing films are used later to confirm alignment is holding.
Non-surgical treatment
Many fractures are stable and heal with bracing, pain control and a staged return to activity, with imaging along the way to confirm nothing is shifting. This is a legitimate treatment, not a lesser one.
When surgery is considered
Unstable fractures, fractures with neurological injury, and those where alignment is failing despite bracing. The aims are to protect the nerves, restore alignment and allow early mobilization. What that requires varies enormously between injuries, which is why these are assessed individually rather than by rule.