Spinous Process Fracture

Definition

The bones that make up the spine are called vertebrae. Each vertebra has a bony section that points out toward the back. These sections are called the spinal process. Muscles and ligaments of the back attach to them to help provide movement and flexibility. These fractures can occur anywhere along the spinal column. They are more common in the vertebrae of the back and not the neck.

A spinous process fracture is a break in one or more of these sections. Most will heal without long-term damage. More severe spinous process fractures, called unstable fractures can result in spinal cord or nerve injury.

Cross Section of Spine

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Causes

Spinous process fractures are caused by severe trauma to the back such as:

• Falls
• Car, motorcycle, or pedestrian accidents
• Severe and sudden twisting or bending
• Severe blows to the back and spine
• Violence, such as a gunshot

Risk Factors

Spinous process fractures more common in older adults. Other factors that may increase the chance of a spinous process fracture includes:

• Osteoporosis
• Certain diseases or conditions that weaken bones, such as tumors or cysts
• Decreased muscle mass

Activities or accidents often linked to these fractures include:

• Falls from heights, such as a ladder, bike, or horse
• Playing certain sports that involve sudden twists and turns, or extreme contact especially without proper protective gear
• Car or motorcycle accidents especially without use of seatbelt
• Severe and sudden twisting or bending
• Severe blows to the back and spine
• Violence, such as a gunshot

Symptoms

Spinal process fractures may cause:

• Severe pain that may be worse during movement, coughing, or breathing
• Tenderness, swelling, and possible bruising
• Numbness, tingling, or muscle weakness
• Decreased range of motion around the affected area of the spine
• Loss of bladder or bowel control (injuries to lower spine)

Unstable fractures may cause damage to the spinal cord. Spinal cord damage can result in temporary or permanent paralysis. Extent or location of paralysis depends on where along the spinal column the injury occurred.

Diagnosis

You will be asked about your symptoms and medical history as well as any accident or activity associated with the pain. A physical exam will be done. A complete neurological exam will also be done to look for signs of nerve damage.

Imaging tests to evaluate your spine may be done with:

• X-rays
• MRI scan
• CT scan

Treatment

Getting care right away is important for any spinal injury. Proper treatment can prevent or decrease long-term complications. Treatment will depend on how serious the fracture is.

Treatment and rehabilitation may take months or years, depending on whether or not there is spinal cord or nerve damage.

Immobilization

When there is a possibility of an unstable spinous fracture, immediate and complete immobilization of the spine is necessary.

Other problems, such as secondary injuries, shock, or airway obstruction wil also be assessed. Stabilizing the injury may include:

• A breathing tube for a blocked airway
• IV fluids
• Admission to the hospital for monitoring

People with unstable fractures usually need to stay in the hospital. Serious injuries may need to be watched in an intensive care unit. Some people with spinal cord damage closer to the neck may need to have help breathing with mechanical ventilation.

Bone Support

Treatment will depend on:

• The severity of the fracture
• Location of the fracture on the spinal column
• Number of fractures
• Which part of the spinous process bone is broken

Treatment options for spinous process fractures may include:

• Back brace—Minor or stable fractures can be treated with a back brace to keep the back in line while it heals.
• Traction—Rigid braces, some with collars, are worn to treat more severe or unstable fractures. Traction allows for minimal movement.
• Surgery—Screws, rods, wires, or cages are used to reconnect bone pieces and hold them in place. Surgery may also be needed to repair vertebrae, relieve pressure on the spinal cord, or remove any damaged vertebral discs.

Rest and Recovery

It may take several weeks to several months for a spinous process fracture to heal. Healing time varies by age and overall health. Children and people in better overall health heal faster.

Physical therapy may be advised to keep muscles strong and maintain range of motion. Long-term rehabilitation may be needed with more severe injuries.

Long-term Rehabilitation

Spinous process fractures can sometimes result in spinal cord and nerve injury, and paralysis. This may require major life changes, involving work, family, and social life. Extensive rehabilitation may be required, including occupational therapy, psychotherapy, and support groups.

Prevention

To help reduce your chance of a spinous process fracture:

• Avoid situations that put you at risk of physical harm
• Always wear a seatbelt when driving or riding in a car
• Do not drive under the influence of alcohol or drugs
• Wear proper padding and safety equipment for sports or activities
• Do weight-bearing exercises to build strong muscles and bones

To help reduce falling hazards at work and home, take these steps:

• Clean spills and slippery areas right away
• Remove tripping hazards such as loose cords, rugs, and clutter
• Use non-slip mats in the bathtub and shower
• Install grab bars next to the toilet and in the shower or tub
• Put rails on both sides of stairways
• Walk only in well-lit rooms, stairs, and halls
• Keep flashlights on hand in case of a power outage