Evaluation

How will my fracture be evaluated?

First aid for an accident victim suspected of having a fracture of the spine includes treating shock by keeping the patient warm, immobilizing the patient, and transporting him/her to hospital as rapidly as possible. An account of the accident and an account of any early neurological impairment should accompany the patient to the hospital. Unless absolutely necessary it is wise not to move the patient until professional rescue help arrives. Special precautions are taken by the professionals to ensure that any spinal injury is not made worse during transport.

In the Emergency Room the focus is on assessing and diagnosing all the injuries, treating shock and pain, and obtaining consultation with the appropriate specialists. Until the extent of a spinal fracture is understood you will not be moved and will normally remain supine on the stretcher. Clothes must be removed to allow for full examination and often this means they need to be cut off. The nervous system examination will be very complete and may be repeated frequently to make sure nothing changes.

X-rays of the thoracic spine will be taken and are usually enough to diagnose the type and location of the fracture. In some cases a Computerized Tomography (CT) examination is also done to clarify the anatomy of the fracture and help with the planning of treatment.

Many compression fractures of the thoracic spine can be treated without a specialist but for more complex fractures or any spinal cord injuries, an orthopaedic surgeon or a neurosurgeon will be consulted.

The evaluation by the surgeon will begin with an account of the accident to form an idea of the mechanism of injury and the amount of force involved. The history will also include the type and location of the pain and the nature of any symptoms in the legs. The examination will include an assessment of the sensation and power in the legs and the anal region. The radiological view of the spine will also be examined and the nature of the fracture explained to you. New x-rays, special x-ray views or CT scans may be ordered in order to complete the assessment of the injury.

The surgeon focuses particularly on the stability of the fracture, how it is likely to behave in the near future and how great the risk to the nerves might be. The prognosis and treatment will be discussed with you taking into account the nature of the fracture, the current neurological status, the risk of future neurological deterioration, your overall medical status, your expectations and the presence of any other injuries.

Many patients with spine fractures have serious injuries to other bones or other systems. When you fall from a height and the result is a heel(s) fracture, common associations are lower limb fractures in general, pelvis and kidney injuries.

If you have sustained a compression fracture with only minor trauma it may be necessary to undertake further tests to see if the bone is abnormal. The most common abnormality is osteoporosis which may be suspected from ordinary x-rays. Special bone density scans may be needed to determine the degree of osteoporosis. If a cancerous deposit in the bone is suspected the tests may include a search for the site of origin of this deposit.