Trauma

Fractures
Ligamentous Injuries
Musculoskeletal Injuries

Trauma to the spine refers to injury that has occurred to bony elements, soft tissues and/or neurological structures. The two things that surgeons are most concerned about, in the case of spinal trauma, are instability of the vertebral column and actual or potential neurological injury.

Stability to the spinal column can be compromised when bony elements are injured or there is disruption to soft tissues such as ligaments. Instability causes the back to become unable to successfully carry normal loads, which can lead to permanent deformity, severe pain and in some cases catastrophic neurological injuries. Most often the instability comes from a fracture in one of the bony parts of the vertebra, specifically the vertebral body, the lamina or the pedicles.

In the case of trauma, dislocations and fractures happen simultaneously and can result in a very unstable spinal column. They can occur in any region of the spine and are associated with a degree of neurological injury. A surgeon needs to restore the mechanical stability of the spine to try and prevent more neurologic injury, progressive deformity or prolonged incapacitation pain.

Fractures
The most common types of fractures affecting the low back are compression fractures which usually result from a fall.

Compression Fractures
The most common types of fractures affecting the low back are compression fractures which usually result from a fall. They can be diagnosed with an x-ray. With most compression fractures, bed rest, physical therapy and conservative medical care is effective. However, there is a small chance that the compression fracture could be caused by a secondary medical condition. Usually your physician will give you a thorough neurological and physical exam in order to rule out osteoporosis or malignancy.

Burst Fractures
Burst fractures usually occur through a violent compressive load resulting in failure of both the anterior and middle columns of the vertebrae. In this case vertebral height is significantly decreased. This fracture is considered unstable and requires immediate stabilization of the body and medical attention.

Flexion/Compression Fracture
Flexion and compression fractures frequently occur at the T1 and L1 levels. The amount of anterior column failure depends on the amount of compressive force. Usually there is some loss of vertebral height with this injury, but as long as the middle and posterior columns are intact, this fracture is considered stable.

Flexion/Distraction Fracture
This type of fracture is also known as a chance fracture, and is often caused by seat belts in cars. In this fracture, all three columns of the vertebral body can fail and there may be injury to bone, ligaments and discs. An interior subluxation is often encountered. This fracture is considered unstable and required immediate stabilization of the body and medical attention.

Compression/Torsion/Translational Fractures
Usually coupled together with or without flexion. Compression effects can occur on the lateral margins of the vertebral body while torsional and translational forces may affect the body or disc and ligament structures.

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Ligamentous Injuries
Many things can happen to a ligament upon injury. The ligament can be strained or sprained or it can tear or it can break all together. Treatments for these different types of injuries are different.

When the body is in poor shape, it does not take much to overstretch a muscle or put a tear in a ligament, both which cause lumbosacral strains or sprains. When this happens, a spasm will immobilize the muscles in the injured area, acting as a splint to protect the ligaments and joints from further damage. Usually ligament injuries occur from a traumatic event, and depending on the severity of the injury, they can take from six weeks to a full year to heal. Many things can happen to a ligament upon injury. The ligament can be strained or sprained or it can tear or it can break all together. Treatments for these different types of injuries are different.

The ligaments which control your back joints can be damaged by an accidental fall, twist or slip, much like the ligaments in your ankle which are damaged by a sprain. A sprained back comes from stretched and damaged pelvic ligaments. The cause of back sprain is very similar to the cause of ankle sprain and the treatment and recovery process can and should be the same as well. Firm support for the pelvic ligaments will help to protect them from further strain while they repair and become strong again.

People are more likely to continue activity with a sprained back than they are to keep walking on a sprained ankle. This is mainly because of the perceived difficulty of supporting the injured ligaments by means of a firm binding. But it is important to note that the danger of ligament damage is much greater in the case of your back than any other part of your body.

Frequent Causes of Back Ligament Injury
We often shift all of our weight to oneleg when forced to stand for long periods. Most people favor the same leg out of habit. When we do this, two-thirds of our body weight is now stretching the ligaments on one side of our pelvis. This simple act causes spinal distortion and postural misalignment. Eventually these ligaments can become as severely distorted as from a serious, sudden injury to the back.

Poor posture is another minor act that can cause major ligament damage. It is tiring to remain standing for a long period of time in situations such as waiting in line, standing up at a party and shopping. Without even noticing many people will compensate for this fatigue by slumping over. When we do that, the entire weight of our body begins pulling against the ligaments in the pelvis and lower back. Years of this can take a toll and cause these ligaments to become stretched and weakened so they cannot properly control our joints. This can cause discomfort and even pain from the simple strain of standing erect.

Work situations are also a common culprit when it comes to ligament strain in the back, from lifting, bending and or twisting which keep our backs under constant or repeated strain. When ligaments become over-stretched they can no longer hold the back joints in proper position and a serious back-sprain condition can result. Click here to learn Lifting Techniques.

Obviously sports are a primary cause for ligament injury and back sprain, although exercise is a good way to strengthen the muscles in our back and prevent ligament injury. Because our backs are vulnerable to strain, even much needed exercises that keep our muscles in shape and our backs strong can be damaging to our joints. In particular, racket sports and any other activities that required exaggerated movement of the spine, over time, can do damage. So while engaging in sports, be mindful of protecting your joints and practicing proper technique to keep from injuring your back.

Weight is another contributor to ligament strain in the back. Every extra pound that we carry around adds to the stress on our backs, particularly extra weight in the abdominal area. This type of weight causes abnormal posture or a sway back to compensate for the extra baggage in front. Aerobic exercises that burn fat, strength exercises that build muscle and exercises, like yoga, that concentrate on building a strong body core and increasing flexibility are all helpful in getting your weight under control.

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Musculoskeletal Injuries
Back pain is most likely to occur when the muscles in the back are not up to the task of protecting the spine. This can happen because a person is out of shape, fatigued or when they subject their back to sudden forces or heavy loads.

For the lower thoracic and lumbar spinal regions the most important muscle groups are:

Quadratus Lumborum
Originates from the last rib (12th) and transverse processes of L1-L4 and inserts at the iliac crest.

Psoas Iliacum
Composed of the psoas major and the iliacus.

Psoas Major
Origins at the transverse processes and vertebral bodies of T12-L5 and insertions at the lesser trochanter of the femur.

Iliacus
Originates at the anterior margin of the iliac crest and inserts at the lesser trochanter of the femur.

Muscle spasms usually signal irritation of the lower back, and often the injury can be treated conservatively with rest, ice and over-the-counter pain medicine. Muscle spasms are a reaction to both muscle injury and ligament injury, so it can be hard to differentiate at first.

When there is a musculoskeletal injury, most often the muscle is torn to some degree. Because the muscles in the body have ample blood supply, they usually repair quickly and easily within a few days.

Muscle injuries often induce swelling to prevent further movement that could cause more injury. When muscles cease to move, they eventually atrophy and weaken, so it's important to get the swelling down as soon as possible, so you can begin to move the injured muscle more quickly.

Treatment for a musculoskeletal injury with accompanying inflammation calls for ice to reduce the swelling and to relieve the spasm.

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