Thoracic Spine Traumatic Burst Fracture

A thoracic spine traumatic burst fracture is a high-energy injury in which a vertebral body in the mid-back is explosively crushed in all directions by an axial load, sending bony fragments outward and, crucially, backward into the spinal canal. Unlike a simple wedge-compression fracture that collapses only the anterior column, a burst fracture violates the posterior vertebral wall, creating a potentially unstable three-column failure that endangers the spinal cord and adjacent neurovascular structures. Radiopaedia

Such injuries typically occur at the thoracolumbar junction (T10–L2) because this transition zone bridges the stiff rib-bearing thoracic spine and the mobile lumbar segments. Although rarer than lumbar injuries, thoracic burst fractures carry a higher risk of neurologic compromise because the relatively narrow thoracic canal leaves little reserve around the cord. Early recognition of the mechanism, timely neuro-orthopaedic evaluation, and evidence-guided diagnostic imaging are therefore essential to minimise permanent deficits. PhysiopediaPubMed

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Thoracic Vertebral Anatomy

Each thoracic vertebra resembles a short cylindrical block (the vertebral body) with an arch of bone (the pedicles, laminae, and spinous process) that protects the spinal cord. The heart-shaped body carries most compressive loads, while the rib articulations help restrict motion. Three biomechanical columns provide stability: the anterior and middle columns formed by the vertebral body and discs, and the posterior column formed by the neural arch and supporting ligaments. A burst fracture fails at least the anterior and middle columns and often the posterior wall as well, thereby threatening the cord.

When a rapid axial compression force (for example, landing hard on one’s feet from a height) exceeds the compressive strength of trabecular bone, the vertebral body implodes. If the load is centralised, force vectors radiate centrifugally, fracturing both superior and inferior endplates and shattering the posterior wall. Retropulsed fragments invade the canal, and torque or flexion components may create laminar, pedicle, or spinous-process fractures. Concomitant vascular micro-tearing can cause spinal-cord oedema or haemorrhage.

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Classification and Types

Several complementary schemes help clinicians grade severity and plan treatment.

• AO Spine Thoracolumbar Classification

  • A3: Incomplete burst (one endplate).

  • A4: Complete burst (both endplates).

  • Stability modifiers (B & C types) describe posterior tension-band injury or translational displacement. AO Foundation Surgery ReferenceRadiopaedia

• Denis Three-Column Concept

  • Type A: Both endplates and posterior wall; most common.

  • Type B: Superior endplate only.

  • Type C: Inferior endplate only; least common. Orthobullets

• Load-Sharing Classification — scores comminution, displacement and kyphosis to predict the need for anterior support.

Recognising the type is not academic; it guides whether bracing alone may suffice or whether surgical decompression, fusion, or both are needed.

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Causes

Below, each cause is unpacked in its own paragraph so search engines—and more importantly, readers—clearly understand the mechanism.

1. Motor-vehicle collisions — Sudden deceleration launches the upper torso forward while the restrained pelvis lags, focusing an axial blast through the thoracic column.

2. Falls from height (buildings, scaffolding, trees) — Landing on feet or buttocks channels ground-reaction forces directly up the spine, crushing vertebral bodies.

3. High-speed sports impacts (gridiron football, rugby tackles) — Helmet-to-helmet or shoulder-pad contact can transmit a vertical jolt sufficient to burst mid-back vertebrae.

4. Industrial crush injuries — Heavy machinery or freight falling onto the shoulders instantaneously compresses the thoracic cage and spine.

5. Direct assault-blows (bat or pipe across the thorax) — Localised high-energy strikes can concentrate enough kinetic energy to fracture the vertebral body circumferentially.

6. Blast overpressure from explosions — Rapid pressure waves compress the torso, and the dynamic force may shatter vertebrae even without external penetration.

7. Aviation or helicopter crash vertical deceleration — Fuselage impact with the ground sends a massive axial load through seated occupants.

8. Equestrian falls — Riders ejected and landing in a crouched, flexed posture absorb ground forces through a flexed thoracic spine.

9. Shallow-water diving — Hitting the pool bottom head-first channels axial energy downward through the thoracic column.

10. Ski or snowboard wipe-outs — Sudden stops against immovable objects (trees, rails) impart vertical and flexion loads to the mid-spine.

11. Mountain-bike over-the-handlebars flips — The cyclist’s body compresses against the handlebars before ground impact, focusing force through the thoracic segment.

12. Pedestrian–vehicle collisions — The bonnet strike may buckle the trunk, then ground impact completes the axial crush.

13. Seizure-induced violent muscle contraction — Rarely, tetanic paraspinal contraction under osteoporotic conditions can burst a weakened vertebra.

14. Primary systemic osteoporosis — Even low-energy bumps become sufficient to burst a vertebra whose trabecular density is markedly reduced.

15. Metastatic cancer erosion (eg, lung, breast, prostate) — Lytic lesions dissolve cancellous bone; minimal trauma then triggers a burst-pattern collapse.

16. Primary bone tumours (myeloma, lymphoma) — Malignant replacement of marrow weakens structural integrity.

17. Long-term corticosteroid therapy — Steroid-induced osteopenia predisposes the vertebral body to crush under forces tolerated by healthy bone.

18. Genetic brittle-bone disorders (osteogenesis imperfecta) — Collagen defects cut structural strength by orders of magnitude, so everyday stresses can burst.

19. Ankylosing spondylitis “bamboo spine” — Rigid ossified ligaments behave like a long-bone; even low-velocity falls create chance fractures that burst at the thoracic apex.

20. Post-radiotherapy osteonecrosis — Radiation undermines micro-circulation; subsequent trivial trauma causes explosive failure of the treated segment.

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Symptoms

1. Sudden sharp mid-back pain that patients describe as “something snapped” immediately after the trauma.

2. Pain that worsens with standing or walking because axial load wedges fracture fragments further.

3. Guarding muscle spasm in the paraspinals, making the back feel “locked.”

4. Visible or palpable step-off or early kyphotic hump at the injured level.

5. Bruising or swelling over the spinous processes signalling underlying bone disruption.

6. Band-like chest wall pain following an intercostal nerve pattern (thoracic radiculopathy).

7. Numbness below the injury as retropulsed fragments press the cord.

8. Tingling or “pins-and-needles” in the legs reflecting partial cord or root irritation.

9. Progressive leg weakness that may start subtly with tripping or buckle-knees.

10. Difficulty walking or a broad-based, unsteady gait.

11. Loss of position sense (proprioception) causing patients to misjudge leg placement.

12. Spastic reflexes or clonus indicating upper-motor-neuron involvement.

13. Urinary retention—the bladder fails to empty when the sacral cord is compressed.

14. Bowel incontinence if autonomic fibres are compromised.

15. Sexual dysfunction (erectile or orgasmic difficulties) owing to sacral parasympathetic injury.

16. Shallow breathing or pain-limited chest excursion because thoracic motion aggravates fracture pain.

17. Low blood pressure and slow heart rate (neurogenic shock) in high thoracic injuries disrupting sympathetic tone.

18. Autonomic dysreflexia—sudden hypertension and sweating triggered by painful stimuli below the lesion in chronic stages.

19. Psychological distress such as anxiety or panic due to sudden disability.

20. Sleep disruption because nocturnal turning in bed rekindles severe pain.

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Diagnostic Tests

Physical-Examination–Based Tests

1. Posture and gait inspection — The clinician observes standing and walking; a fresh thoracic burst may reveal an antalgic stoop or step-off contour.

2. Palpation of spinous processes — Gentle pressure pinpoints maximal tenderness directly over the fractured vertebra.

3. Vertebral percussion test — Tapping the spinous process with a reflex hammer elicits sharp pain in burst fractures but not in soft-tissue bruises.

4. Thoracic range-of-motion assessment — Active flexion/extension is grossly reduced; pain limits rotation and side-bend.

5. Neurological sensory mapping — Light-touch and pin-prick are tested in T1–L1 dermatomes to locate cord compression.

6. Manual muscle testing (MMT) — The clinician grades key myotomes (hip flexors, quads, ankle dorsiflexors) to gauge motor deficit.

7. Deep-tendon-reflex check — Hyperreflexia below the lesion suggests upper-motor-neuron injury, while absent reflexes at the level may indicate cord shock.

8. Pathological reflexes (Babinski, clonus) — Presence confirms corticospinal tract involvement and raises urgency for decompression.

Manual & Functional Provocation Tests

9. Thoracic spring test — A controlled anterior-to-posterior pressure is applied to each spinous process; burst levels give way painfully or feel unstable.

10. Prone instability test — Lifting legs off the couch activates spinal extensors; worsening pain suggests ligamentous injury coexisting with the burst.

11. Chest-expansion measurement — Reduced rib-cage excursion (<2 cm) hints at pain-limited ventilation in acute thoracic fracture.

12. Segmental rib springing — Posterolateral rib compression reproduces radicular pain if costo-vertebral joints are involved.

13. Active seated slump test — Neural tension testing may provoke distal paraesthesias, revealing subtle cord irritation.

Laboratory & Pathologic Tests

14. Complete blood count (CBC) — Screens for anaemia from occult trauma and establishes baseline for surgery.

15. Inflammatory markers (ESR, CRP) — Elevated levels in delayed presentations may warn of superimposed infection (e.g., post-traumatic discitis).

16. Serum calcium, phosphate, vitamin D — Identify metabolic bone weakness that may have predisposed the burst.

17. Serum alkaline-phosphatase & P1NP — Bone-turnover markers help gauge osteoporotic activity.

18. Tumour markers (PSA, CA 15-3, light chains) — Rule out metastatic or myelomatous pathological fractures.

 Electro-diagnostic Tests

19. Somatosensory-evoked potentials (SSEPs) — Stimulating peripheral nerves and recording cortical responses quantifies dorsal-column pathway integrity intra-operatively.

20. Motor-evoked potentials (MEPs) — Transcranial magnetic pulses elicit muscle responses, instantly signalling corticospinal tract continuity.

21. Electromyography (EMG) — Needle electrodes in paraspinals show denervation potentials if nerve roots are compressed.

22. Nerve-conduction studies (NCS) — Differentiate peripheral neuropathy from central cord injury when lower-limb symptoms appear disproportionate.

Imaging Tests (The Diagnostic Corner-stone)

23. Plain thoracic spine radiographs (antero-posterior and lateral) — First-line, inexpensive, but may miss subtle fractures; they often show loss of vertebral height and widened inter-pedicular distance. Radiopaedia

24. Sitting or standing flexion–extension X-rays — Performed once acute pain subsides to spot occult instability.

25. Multi-detector computed tomography (CT) — Gold standard for visualising burst-fragment comminution, canal invasion, and load-sharing score. PubMed

26. CT angiography — Added if bone fragments threaten adjacent great vessels (e.g., thoracic aorta).

27. Magnetic resonance imaging (MRI) T1/T2 — Identifies cord oedema, haemorrhage, and posterior ligament complex tears invisible on CT. PubMed

28. MRI STIR sequence — Highlights marrow oedema in subtle or occult burst fractures and disc-endplate injuries.

29. Dual-energy X-ray absorptiometry (DEXA) — Baseline bone-density test essential in older patients to guide anti-osteoporotic therapy.

30. Whole-body bone scan or PET-CT — Detects multiple metastatic lesions when pathological fracture is suspected.

Recent studies confirm MRI’s superior sensitivity for unstable occult injuries that CT might miss, underpinning modern protocols that combine the two. ScienceDirect

Non-Pharmacological Treatments

Non-drug approaches form the backbone of early management, promoting bone healing, pain relief, and functional recovery without medication side effects. Each entry includes a description, purpose, and underlying mechanism.

Physiotherapy & Electrotherapy Therapies

1. Spinal Mobilization
   Description: Gentle, hands-on movements applied by a physical therapist to thoracic vertebrae.
   Purpose: Restore small joint motion, relieve stiffness, and reduce pain.
   Mechanism: Mobilization improves synovial fluid exchange, decreases nociceptive input, and stimulates mechanoreceptors that modulate pain pathways.

2. Traction Therapy
   Description: A mechanical or manual pulling force applied along the spine’s axis.
   Purpose: Decompress vertebral segments, reduce intradiscal pressure, and relieve nerve irritation.
   Mechanism: Traction temporarily enlarges intervertebral foramen and unloads compressed structures, decreasing substance P and inflammatory cytokines.

3. Transcutaneous Electrical Nerve Stimulation (TENS)
   Description: Low-voltage electrical currents delivered via skin electrodes.
   Purpose: Alleviate acute and chronic back pain.
   Mechanism: TENS stimulates large A-beta fibers, activating inhibitory interneurons in the dorsal horn (gate control theory) and promoting endorphin release.

4. Interferential Current Therapy (IFC)
   Description: Two medium-frequency currents intersecting to produce a low-frequency effect in deeper tissues.
   Purpose: Penetrate deeper muscle layers for pain relief and edema reduction.
   Mechanism: IFC enhances circulation, disperses inflammatory mediators, and increases endorphins more deeply than TENS.

5. Therapeutic Ultrasound
   Description: High-frequency sound waves applied via a transducer head.
   Purpose: Promote tissue healing, reduce muscle spasm, and break down scar tissue.
   Mechanism: Ultrasound generates deep heat and mechanical micro-vibrations (acoustic streaming), enhancing collagen extensibility and cell membrane permeability.

6. Pulsed Electromagnetic Field Therapy (PEMF)
   Description: Exposure to time-varying electromagnetic fields.
   Purpose: Accelerate bone healing and reduce inflammation.
   Mechanism: PEMF upregulates osteoblast activity, boosts calcium uptake, and modulates inflammatory cytokines (e.g., IL-1, TNF-α).

7. Low-Level Laser Therapy (LLLT)
   Description: Low-intensity laser light applied to skin overlying injured vertebrae.
   Purpose: Decrease pain and promote tissue repair.
   Mechanism: Photobiomodulation increases mitochondrial ATP production, reduces oxidative stress, and modulates inflammatory mediators.

8. Diathermy (Shortwave/Microwave)
   Description: High-frequency electromagnetic energy producing deep heating in tissues.
   Purpose: Relieve muscle spasm, increase blood flow, and enhance tissue extensibility.
   Mechanism: Deep thermal effects loosen tight muscles, improve circulation, and accelerate metabolic processes.

9. Shockwave Therapy
   Description: High-energy acoustic waves delivered to bone and soft tissue.
   Purpose: Stimulate bone remodeling and reduce chronic pain.
   Mechanism: Microtrauma from shockwaves triggers osteogenesis via mechanotransduction and growth factor release.

10. Neuromuscular Electrical Stimulation (NMES)
    Description: Electrical currents to elicit muscle contractions.
    Purpose: Maintain muscle mass and prevent atrophy during immobilization.
    Mechanism: NMES recruits type II muscle fibers, preserves neuromuscular junctions, and promotes muscle protein synthesis.

11. Cryotherapy (Cold Therapy)
    Description: Application of ice packs or cold sprays.
    Purpose: Reduce acute pain, swelling, and inflammation immediately post-injury.
    Mechanism: Vasoconstriction limits edema, slows nerve conduction velocity, and decreases metabolic demand.

12. Thermotherapy (Heat Therapy)
    Description: Application of moist heat packs or warm therapy.
    Purpose: Relieve muscle spasm and stiffness in subacute/chronic phases.
    Mechanism: Vasodilation improves blood flow, enhances nutrient delivery, and eases muscle tension.

13. Hydrotherapy (Aquatic Therapy)
    Description: Exercises performed in warm water pools.
    Purpose: Facilitate gentle mobilization with buoyant support.
    Mechanism: Buoyancy unloads weight, hydrostatic pressure reduces swelling, and warmth relaxes muscles.

14. Manual Soft-Tissue Release
    Description: Therapist-applied massage, myofascial release, and trigger-point therapy.
    Purpose: Reduce muscle tightness and adhesions.
    Mechanism: Mechanical pressure breaks down fascial restrictions, improves lymphatic drainage, and modulates pain pathways.

15. Balance and Proprioceptive Training
    Description: Exercises using wobble boards or foam pads.
    Purpose: Restore postural control after injury.
    Mechanism: Challenging proprioceptors retrains neuromuscular coordination and spinal stabilization reflexes.

Exercise Therapies

16. Core-Stabilization Exercises
    Description: Isometric holds (e.g., planks) targeting deep trunk muscles.
    Purpose: Enhance spinal support and reduce mechanical stress on the healed vertebra.
    Mechanism: Activates transversus abdominis and multifidus to stabilize vertebral segments.

17. McKenzie Extension Exercises
    Description: Repeated prone extensions of the spine.
    Purpose: Centralize pain and improve spinal alignment.
    Mechanism: Mechanical loading shifts disc material anteriorly and reduces posterior fragment impingement.

18. Dynamic Back Strengthening
    Description: Controlled resisted spinal extensions using bands or machines.
    Purpose: Build resilience in paraspinal muscles.
    Mechanism: Eccentric and concentric loading stimulates hypertrophy and tendon remodeling.

19. Flexibility & Stretching Programs
    Description: Gentle thoracic extensions and hamstring stretches.
    Purpose: Maintain spinal range of motion and prevent compensatory patterns.
    Mechanism: Sustained stretches reduce connective tissue stiffness and improve joint mobility.

20. Aquatic Aerobic Conditioning
    Description: Low-impact aerobic routines in water.
    Purpose: Improve cardiovascular fitness without spinal overload.
    Mechanism: Buoyancy lowers ground reaction forces while warmth relaxes muscles.

Mind-Body Techniques

21. Yoga Therapy
    Description: Gentle, guided postures focusing on spinal alignment.
    Purpose: Promote flexibility, relaxation, and pain coping skills.
    Mechanism: Combines stretching with diaphragmatic breathing to reduce sympathetic overdrive and muscle tension.

22. Tai Chi
    Description: Slow, flowing movements emphasizing balance and posture.
    Purpose: Enhance proprioception, reduce fear of movement, and decrease pain.
    Mechanism: Mindful motion improves neuromuscular control and modulates nociceptive processing.

23. Guided Meditation
    Description: Audio- or therapist-led relaxation sessions.
    Purpose: Lower stress, anxiety, and perceived pain.
    Mechanism: Activates parasympathetic pathways, reduces cortisol, and alters pain perception.

24. Biofeedback
    Description: Real-time feedback of muscle activity and breathing patterns.
    Purpose: Teach patients to consciously relax spinal muscles.
    Mechanism: Visual or auditory cues reinforce voluntary down-regulation of electromyographic activity.

25. Mindfulness-Based Stress Reduction (MBSR)
    Description: Structured program of mindfulness meditation, body scan, and gentle yoga.
    Purpose: Cultivate non-judgmental awareness of pain sensations.
    Mechanism: Changes in brain circuitry reduce the affective component of pain and improve coping.

Educational Self-Management Strategies

26. Pain Neuroscience Education
    Description: Teaching the biology of pain and tissue healing.
    Purpose: Decrease fear-avoidance beliefs and improve engagement in activity.
    Mechanism: Corrects pain misconceptions, reducing catastrophizing and central sensitization.

27. Home Exercise Program Planning
    Description: Customized exercise sheets with progression guidelines.
    Purpose: Empower patients to continue rehabilitation independently.
    Mechanism: Structured routines build self-efficacy and long-term adherence.

28. Ergonomic Training
    Description: Instruction on proper sitting, standing, and lifting mechanics.
    Purpose: Prevent re-injury during daily tasks.
    Mechanism: Minimizes spinal shear and axial loads through neutral postures.

29. Activity Pacing & Graded Exposure
    Description: Teaching patients to balance rest and activity.
    Purpose: Avoid flare-ups while gradually increasing tolerance.
    Mechanism: Prevents cyclical deconditioning and reduces fear of movement.

30. Symptom Monitoring Diaries
    Description: Daily logs of pain levels, activities, and triggers.
    Purpose: Identify patterns and optimize self-management.
    Mechanism: Increases patient awareness and facilitates timely adjustments in behavior.

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Drugs

Pharmacological management targets pain reduction, inflammation control, muscle relaxation, and neuroprotection. Dosages below reflect average adult guidelines; individual adjustments may be necessary.

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Dietary Molecular Supplements

Nutrition supports bone repair at the molecular level. The following ten supplements have shown evidence in enhancing fracture healing:

1. Collagen Peptides
   Dosage: 10 g/day
   Function: Provides amino acids for bone matrix synthesis.
   Mechanism: Stimulates osteoblast proliferation and collagen type I deposition.

2. Vitamin D₃ (Cholecalciferol)
   Dosage: 1,000–2,000 IU/day
   Function: Promotes calcium absorption and mineralization.
   Mechanism: Binds vitamin D receptors in enterocytes, increasing calbindin-mediated uptake.

3. Vitamin K₂ (Menaquinone-7)
   Dosage: 90–180 µg/day
   Function: Activates osteocalcin for bone matrix binding.
   Mechanism: γ-carboxylation of osteocalcin enables calcium incorporation into hydroxyapatite.

4. Magnesium
   Dosage: 300–400 mg/day
   Function: Cofactor for bone formation enzymes.
   Mechanism: Regulates parathyroid hormone and activates alkaline phosphatase.

5. Zinc
   Dosage: 15–30 mg/day
   Function: Supports osteoblastic activity and collagen synthesis.
   Mechanism: Zinc-dependent matrix metalloproteinases remodel bone matrix.

6. Vitamin C (Ascorbic Acid)
   Dosage: 500–1,000 mg/day
   Function: Essential for collagen cross-linking.
   Mechanism: Cofactor for prolyl and lysyl hydroxylases in collagen maturation.

7. Boron
   Dosage: 3 mg/day
   Function: Modulates bone-calcium metabolism.
   Mechanism: Influences magnesium and vitamin D metabolism, reducing urinary calcium loss.

8. Silicon (Orthosilicic Acid)
   Dosage: 10–20 mg/day
   Function: Essential for connective tissue and bone matrix.
   Mechanism: Stimulates type I collagen synthesis and cross-linking.

9. Manganese
   Dosage: 2–5 mg/day
   Function: Cofactor for glycosaminoglycan synthesis.
   Mechanism: Activates enzymes in proteoglycan formation for cartilage and bone.

10. Omega-3 Fatty Acids (EPA/DHA)
    Dosage: 1–2 g/day
    Function: Reduces inflammation and supports bone formation.
    Mechanism: Competes with arachidonic acid, lowering pro-inflammatory eicosanoids and cytokines.

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Advanced (Bisphosphonates, Regenerative, Viscosupplementations, Stem Cell Drugs)

These biopharmaceuticals and biologics target bone density, regeneration, and joint lubrication:

1. Alendronate
   Dosage: 70 mg weekly
   Function: Inhibits osteoclast-mediated bone resorption.
   Mechanism: Binds hydroxyapatite, induces osteoclast apoptosis.

2. Risedronate
   Dosage: 35 mg weekly
   Function: Reduces bone breakdown.
   Mechanism: Disrupts osteoclast cytoskeleton and farnesyl pyrophosphate synthesis.

3. Zoledronic Acid
   Dosage: 5 mg IV annually
   Function: Potent anti-resorptive.
   Mechanism: Nitrogen-containing bisphosphonate that inhibits FPPS in osteoclasts.

4. Teriparatide (PTH 1–34)
   Dosage: 20 µg daily SC
   Function: Anabolic bone formation.
   Mechanism: Intermittent PTH receptor activation stimulates osteoblasts.

5. Romosozumab
   Dosage: 210 mg SC monthly
   Function: Dual effect—builds bone and stops resorption.
   Mechanism: Sclerostin antibody that enhances Wnt signaling.

6. Hyaluronic Acid Injection
   Dosage: 20 mg per facet joint
   Function: Enhances joint lubrication and shock absorption.
   Mechanism: Restores viscoelasticity in degenerated facet capsules.

7. Cross-Linked HA Derivative
   Dosage: 40 mg per injection
   Function: Longer-lasting viscosupplementation.
   Mechanism: High-molecular-weight HA reduces synovial inflammation and friction.

8. Autologous Mesenchymal Stem Cell (MSC) Injection
   Dosage: 1–5 million cells per mL
   Function: Promotes bone regeneration.
   Mechanism: MSCs differentiate into osteoblasts and secrete growth factors (VEGF, BMPs).

9. Allogeneic MSC with Scaffold
   Dosage: 10 million cells in hydrogel scaffold
   Function: Structural bone defect repair.
   Mechanism: Scaffold supports cell survival and targeted bone deposition.

10. Bone Marrow Aspirate Concentrate (BMAC)
    Dosage: 10–20 mL concentrate
    Function: Delivers growth factors and progenitor cells.
    Mechanism: BMAC provides PDGF, TGF-β, and MSCs to stimulate osteogenesis.

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Surgical Procedures

Surgery is indicated for unstable burst fractures or neurological compromise. Procedures focus on decompression, stabilization, and restoration of alignment:

1. Posterior Pedicle Screw Fixation

   • Procedure: Screws placed in pedicles above and below the fracture, connected by rods.

   • Benefits: Rigid stabilization, indirect canal decompression, early mobilization.

2. Anterior Corpectomy & Cage Reconstruction

   • Procedure: Removal of fractured vertebral body and insertion of a titanium cage.

   • Benefits: Direct decompression, restores vertebral height, anterior column support.

3. Vertebroplasty

   • Procedure: Percutaneous injection of polymethylmethacrylate (PMMA) into the fractured vertebra.

   • Benefits: Immediate pain relief, minimal invasiveness.

4. Kyphoplasty

   • Procedure: Balloon tamp expands collapsed vertebra, followed by PMMA injection.

   • Benefits: Restores vertebral height, reduces kyphotic deformity, pain control.

5. Posterior Decompression Laminectomy

   • Procedure: Removal of lamina to relieve spinal cord pressure.

   • Benefits: Alleviates neural compression, reduces risk of paralysis.

6. Transpedicular Decompression

   • Procedure: Fractured fragments removed via transpedicular approach.

   • Benefits: Combines decompression with stabilization, preserves posterior elements.

7. Minimally Invasive Percutaneous Fixation

   • Procedure: Small incisions, image-guided screw placement.

   • Benefits: Less muscle damage, reduced blood loss, faster recovery.

8. Open Reduction Internal Fixation (ORIF)

   • Procedure: Open approach to realign fragments, use plates/rods for fixation.

   • Benefits: Precise anatomical correction, robust stability.

9. Circumferential Fusion

   • Procedure: Combined anterior and posterior fusion in one or staged surgery.

   • Benefits: Maximizes stability for multi-column injury.

10. Expandable Vertebral Body Replacement

    • Procedure: Use of an expandable cage to tailor vertebral height restoration.

    • Benefits: Customized fit, immediate load sharing, preservation of sagittal profile.

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Prevention Strategies

1. Maintain Bone Health: Adequate calcium, vitamin D, and weight-bearing exercise.

2. Fall-Proof Home: Remove trip hazards, install grab bars, improve lighting.

3. Safe Lifting Techniques: Bend at hips/knees, keep load close to body.

4. Use Protective Gear: Seat belts in vehicles, spine boards in sports.

5. Strength & Flexibility Training: Core exercises to support spine.

6. Ergonomic Workstations: Neutral spine posture at desk, proper chair height.

7. Regular Screening: DEXA scans for osteoporosis risk.

8. Avoid High-Risk Activities: Extreme sports without proper training.

9. Smoking Cessation: Smoking impairs bone healing and density.

10. Medication Review: Minimize long-term corticosteroids that weaken bone.

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When to See a Doctor

• Sudden, severe mid-back pain following trauma

• Numbness, tingling, or weakness in legs

• Loss of bladder or bowel control

• Difficulty walking or maintaining balance

• Visible spinal deformity or “step-off” on palpation

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“What to Do” & “What to Avoid”

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Frequently Asked Questions

1. What exactly is a burst fracture?
   A burst fracture is when the vertebral body is crushed in all directions by a high-energy force, sending fragments into the spinal canal. It’s more severe than a simple compression fracture because of the risk of spinal cord injury.

2. How long does it take to heal?
   Healing typically requires 3–6 months for bone consolidation, with ongoing rehabilitation for up to a year to restore strength and mobility.

3. Will I need surgery?
   Surgery is recommended if the fracture is unstable (three-column involvement) or if there are neurological deficits. Stable fractures without cord compromise often heal with bracing and rehab.

4. Can I walk after a burst fracture?
   Yes—guided early ambulation is encouraged in stable fractures. A back brace and supervised therapy help you walk safely within days of injury.

5. What role do braces play?
   Braces (e.g., thoracolumbosacral orthosis) limit flexion/extension to protect the fracture site, reduce pain, and promote proper alignment during healing.

6. Are strong painkillers necessary?
   Pain control is individualized. Mild fractures may only need acetaminophen or NSAIDs; severe pain may require short-term opioids under close supervision.

7. How can I speed up bone healing?
   Adequate protein, calcium, vitamin D, and adherence to non-pharmacological treatments like PEMF and LLLT can accelerate bone repair.

8. Is physical therapy safe?
   Yes—when guided by a trained therapist who tailors exercises to your healing stage, ensuring you don’t overload the fracture.

9. Do I need to avoid all activities?
   No—moderate, braced walking and gentle exercises are beneficial. Complete immobilization beyond a few days can delay recovery.

10. Can burst fractures cause permanent paralysis?
    If fragments severely damage the spinal cord, permanent deficits can occur. Prompt decompression surgery minimizes this risk.

11. What complications should I watch for?
    New numbness, bladder/bowel changes, worsening pain, fever, or signs of infection—these require immediate medical attention.

12. Will I return to normal life?
    Most patients regain pain-free function with comprehensive rehab, though high-impact sports may be restricted permanently.

13. Can children get burst fractures?
    Yes—typically in high-energy trauma. Pediatric spine biomechanics differ, so management protocols are specialized.

14. What about driving?
    Driving is usually restricted until pain is well controlled and you can wear a seatbelt without discomfort—often after 4–6 weeks.

15. Are there long-term back problems?
    Some patients develop chronic back pain or kyphotic deformity. Long-term follow-up and strengthening programs help mitigate these risks.

Disclaimer: Each person’s journey is unique, treatment plan, life style, food habit, hormonal condition, immune system, chronic disease condition, geological location, weather and previous medical  history is also unique. So always seek the best advice from a qualified medical professional or health care provider before trying any treatments to ensure to find out the best plan for you. This guide is for general information and educational purposes only. Regular check-ups and awareness can help to manage and prevent complications associated with these diseases conditions. If you or someone are suffering from this disease condition bookmark this website or share with someone who might find it useful! Boost your knowledge and stay ahead in your health journey. We always try to ensure that the content is regularly updated to reflect the latest medical research and treatment options. Thank you for giving your valuable time to read the article.

The article is written by Team Rxharun and reviewed by the Rx Editorial Board Members

Last Updated: May 28, 2025.

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