eMedicine Specialties > Sports Medicine > Spine

Lumbosacral Spine Acute Bony Injuries

Federico C Vinas, MD, Consulting Neurosurgeon, Department of Neurological Surgery, Halifax Medical Center
Contributor Information and Disclosures

Updated: Jul 25, 2008

Introduction

Background

Injuries to the lumbar spine have received only a small amount of attention compared with other athletic injuries. This can be explained by a number of reasons. Spinal fractures are relatively uncommon in sports participation compared with other types of injuries; most injuries to the lumbar spine are relatively minor and fit into the category of soft-tissue injuries. These soft-tissue injuries are usually self-limited and resolve without coming to the attention of healthcare professionals.

The mechanisms and severity of sports-related lumbar spinal injuries reflect a competitive and risk-taking culture.1, 2, 3, 4, 5, 6 Lumbar spine bony injuries are often limited to specific sports, most frequently seen in sports such as automobile or motorcycle racing,7, 8, 9 skydiving,10 power weight lifting,11, 12 wrestling,13 gymnastics,14, 15, 16 football,17, 18, 19, 20 horseback riding,21 and high-speed snow sports.22, 23, 24, 25, 26 This article reviews the diagnosis and management of acute lumbar vertebral fractures.

For excellent patient education resources, visit eMedicine's Sports Injury Center and Back, Ribs, Neck, and Head Center. Also, see eMedicine's patient education articles Vertebral Compression Fracture and Back Pain.

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Frequency

United States

The epidemiology of thoracic and lumbar spine injuries in athletes is very difficult to document. Most epidemiologic studies on lumbar spine injuries in athletes lack prospective data. The thoracolumbar junction and lumbar spine are common sites for fractures due to the high mobility of the lumbar spine compared with the more rigid thoracic spine. Injury to the cord or cauda equina occurs in approximately 10-38% of adult thoracolumbar fractures and in as many as 50-60% of fracture dislocations. The rate of bony injury without neurologic consequence is undoubtedly higher.

In the United States, Keene reported an overall rate of 7% for sport-related lumbar injuries in the athlete population.25 Most of these injuries occurred during practice or preseason conditioning, and only 6% occurred during actual competition. Lumbar spine injuries were significantly more common in football17, 18, 19, 20 and gymnastics.14, 15, 16

Statistics from the US Air Force Academy indicated that 9% of all athletic injuries affect the spinal column. In an analysis of injuries in a professional football team, Ryan et al reported a 6% rate of spinal injuries.9 Snook reviewed all musculoskeletal injuries sustained by college wrestlers and female gymnasts and found a rate of thoracolumbar spine injuries of 2% for the wrestlers13 and 13% for the female gymnasts.27

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International

Information on the incidence of sports-related spinal injuries in other countries is also limited and difficult to determine due to differences in data collection and reporting among countries. In England, Williams estimated that spinal injuries accounted for 15% of all injuries sustained in sports.10 Furthermore, injuries to the thoracic and lumbar spine seemed to be more frequent in automobile racing, horseback riding, parachuting, mountain climbing, and weightlifting.

Functional Anatomy

The lumbar spine consists of a mobile segment of 5 vertebrae, located between the relatively immobile segments of the thoracic and sacral segments at either end. The thoracic spine is stabilized by the attached rib cage and intercostal musculature, whereas the sacral segments are fused, providing a stable articulation with the ilium. The lumbar vertebrae are particularly large and heavy compared with the cervical and thoracic vertebrae. The bodies are wider, the pedicles are shorter and heavier, and the transverse processes project somewhat more laterally and ventrally when compared with other spinal segments. The laminae are shorter vertically than the bodies and are bridged by strong ligaments. Finally, the spinal processes are broader and stronger than those in the thoracic and cervical spine.28

The lumbar spine must transmit compressive, bending, and twisting forces that are generated between the upper and lower body. Consequently, as one moves more caudally into the lumbar spine, the muscle groups and ligaments become larger and stronger.

The intervertebral discs consist of 2 components, the annulus fibrosus and the nucleus pulposus. The annulus is a dense fibrous ring located at the periphery of the disc, which has strong attachments to the vertebrae and serves to confine the nucleus pulposus. The lumbar spine is surrounded by powerful musculature and ligaments, which dynamically stabilize the spine.

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Sport-Specific Biomechanics

The lumbar spine is a complex, 3-dimensional (3-D) structure that is capable of flexion, extension, lateral bending, and rotation. In the spine, the total range of motion is the result of a summation of the limited movements that occur between the individual vertebrae. Strong muscles and ligaments are crucial for supporting the bony structures and for initiating and controlling movement.

The most common movement of the lumbar spine is flexion. During flexion, anterior compression of the intervertebral disc and widening of the spinal canal occurs along with some sliding movement of the articular process in the zygapophyseal joint. This movement is limited by the posterior ligamentous complex and the dorsal muscles. Extension of the lumbar spine is more limited, producing posterior compression on the disc, narrowing of the spinal canal, and a sliding motion of the zygapophyseal joint. The anterior longitudinal ligament, ventral muscles, lamina, and spinous processes limit the extension of the lumbar spine.

Lateral bending involves lateral compression of the intervertebral disc, along with sliding separation of the zygapophyseal joint on the convex side. An overriding of the zygapophyseal joint occurs on the concave side. The intertransverse ligaments limit the lateral bending of the spine. Rotation of the lumbar spine involves compression of the annulus fibrosus fibers. It is limited by the geometry of the facet joints and the iliolumbar ligaments. The motion of the lumbar spine cannot be considered without evaluating the synchronous movements of the cervical and thoracic spine. The entire spinal column moves as one unit in all planes of motion. Each region of the spine has its own characteristic curvature. These curves allow an upright posture while maintaining the center of gravity over the pelvis and lower limbs. Although most rotation is accomplished at the cervical spine, flexion and lateral bending are primarily cervical and lumbar functions.

Spinous process fractures may occur as a result of direct trauma to the posterior spine or as a result of forcible flexion and rotation. These injuries are usually not associated with neurologic deficits. Violent muscular contraction or direct trauma can cause fractures of the transverse processes. For example, a football helmet blow to the back can cause fractures of either the spinous or transverse processes. Burst fractures are usually associated with axial loading and compression of the spine. Acute traumatic spondylolisthesis is usually associated with major trauma and extreme hyperextension of the spine.

The intervertebral discs are thick and strong. The annulus fibrosus receives most of the forces that are transmitted from one vertebral body to another, and it is designed to resist tension and shearing forces. The nucleus pulposus is designed to resist compression forces; it receives primarily vertical forces from the vertebral bodies and redistributes them in a radial fashion to the horizontal plane. This structure allows the intervertebral discs to dissipate the axial loading.

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Clinical

History

In the assessment of an injured athlete, the history should include a description of the trauma and an exact description of the pain and any exacerbating factors. A past history of any spinal problem should always be obtained. Patients with lumbosacral fractures present with severe pain, deformity, and neurologic deficits related to compression of neural structures.

In healthy athletes, a significant traumatic event is required to produce a fracture of the lumbar spine, whereas in patients with caused by metabolic or endocrine imbalance, a relatively minor trauma can produce a pathologic fracture.

Any neurologic change at the time of the event, such as weakness, paresthesias, or radicular pain, should be documented. For example, lumbar fractures may cause solitary or multiple radiculopathies. Massive disc herniations, fracture-dislocations, and burst fractures can cause a cauda equina syndrome with variable paraparesis, asymmetrical saddle anesthesia, radiating pain, and sphincter disturbances. Complete damage of the sacral cord and nerve roots is manifested as no motor function or sensation below L1.

  • Classification
    • The most useful classification of lumbar spine fractures is Denis's 3-column spine stability classification.29, 30 According to this model, the spine consists of 3 columns.
    • The anterior column is represented by the anterior half of the vertebral body, the anterior half of the annulus fibrosus, and the anterior longitudinal ligament.
    • The middle column consists of the posterior half of the vertebral body, the posterior half of the annulus fibrosus, and the posterior longitudinal ligament.
    • The posterior column is represented by the supraspinous and infraspinous ligaments, ligamentum flavum, articular processes, joint capsules, spinous processes, and the laminae.
    • Instability occurs when 2 or more columns are injured. Because contiguous columns are commonly affected by the same injury, instability is heavily dependent on middle column failure.
    • Magerl and colleagues proposed a classification scheme with 3 morphologic injury patterns, types A, B, and C, which result from 3 basic forces, compression, distraction, and rotation, respectively.31 These categories have been applied to all levels of the spine, and subcategories and subdivisions have been described based on the mechanism and severity of the fractures.
  • Mechanism of injury and relative force sustained
    • A detailed history must be obtained, if possible, to ascertain the mechanism of injury and the relative force sustained.
    • Individuals who fall often receive hyperflexion or compression injuries, such as spinous process fractures, burst fractures, or traumatic spondylolisthesis. These injuries are commonly associated with pelvic and lower-extremity fractures.
    • Automobile racers who were using seat belts during motor vehicle accidents often receive compression or distraction injuries to the spine, which are frequently associated with cervical spine injuries. In these patients, burst fractures and fractures dislocations are relatively common. 
    • Head injuries and extremity fractures commonly accompany vertebral fractures.
    • Abdominal or urologic trauma can occur frequently in patients with lumbar fractures.
    • The possible presence of concurrent direct injuries to adjacent intracavitary soft-tissue structures, such as renal, spleen, or liver lacerations, must be considered. In general, the more caudal the vertebral injury, the greater the biomechanical forces that are sustained and the greater the propensity for injuries to the pelvis and sacrum.

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Physical

The initial management of patients with a lumbar spine injury begins in the field. Any patient who may have a spinal injury is placed on a board in a neutral supine position and immobilized in a neck collar for expeditious transportation to a trauma center. In the emergency department, all patients should be treated as having a spinal injury until this condition is excluded. Fractures of the thoracolumbar junction can produce a mixture of cord and root syndromes caused by lesions of the conus medullaris and lumbar nerve roots, whereas lower lumbar fractures may cause solitary or multiple root deficits.

The Advanced Trauma Life Support (ACLS) guidelines of the American College of Surgeons should be followed. Stabilization of the patient's airway and hemodynamic status in order to secure adequate oxygenation and tissue perfusion should precede any treatment. A Foley catheter should be inserted. In patients with neurologic deficit, immediate peritoneal lavage is often advocated to rule out intra-abdominal injuries. Once the patient has been resuscitated, plain films of the cervical, thoracic, and lumbosacral spine should be taken.

  • Physical examination
    • The physical examination of the athlete with an acute spinal fracture is usually limited by the patient's severe pain.
    • During the spinal examination, the overlying skin should be inspected for abrasions or contusions.
    • Attention should be directed to general deviations from the normal spine curves (ie, thoracic kyphosis, lumbar lordosis).
    • Muscle spasm from pain frequently flattens the spine, whereas spinal fractures may cause a kyphotic or scoliotic deformity.
    • The spine should be palpated for areas of tenderness or fractured, displaced spinous processes.
  • Neurologic examination
    • Sometimes, the initial examination of these patients can be difficult because of multiple trauma, spinal shock, or sedation. Any neurologic deficit should be documented according to the American Spinal Injury Association (ASIA) Motor Index.
    • A motor examination should be performed on all conscious patients. Muscle strength and weakness are graded based on a strength scale from 0 to 5, with 5 considered normal and 0 considered paralysis. Muscle strength grading is as follows:
      • Grade 0 – No contraction
      • Grade 1 – Flicker of movement
      • Grace 2 – Can move when gravity is eliminated
      • Grade 3 – Can elevate against gravity
      • Grade 4 – Can move against resistance (-4 for slight resistance, 4 for moderate resistance, and +4 for strong resistance)
      • Grade 5 – Normal strength
    • A detailed neurologic evaluation should include detection of a sensory level, posterior column function, and normal and abnormal reflexes and an examination of rectal tone and perianal sensation. The cutaneous abdominal reflex, bulbocavernosus, anal wink, and the presence of a Babinski sign should also be noted and documented. The Beevor sign consists of a cephalic movement of the umbilicus when the patient is asked to elevate the head in the supine position. This is due to paralysis of the lower abdominal muscles.
    • A rectal examination to check for rectal tone and voluntary sphincter function should always be included.
    • Repeated neurologic examinations should be performed and documented at regular intervals to serve as references for improvement or deterioration in the patient's neurologic status over time.
    • In patients with a complete spinal injury (paraplegia or quadriplegia), spinal shock can last 24-48 hours, suppressing all reflex activity below the level of the lesion. The return of reflex activity (bulbocavernosus and anal reflexes) in the absence of any return of sensation or motor function is generally a poor prognostic indicator. Some return of motor or sensory function below the level of the lesion encourages the possibility of some return of useful neurologic function.

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Causes

The forces responsible for spinal fractures are compression, flexion, extension, rotation, shear, distraction, or a combination of these mechanisms. In athletes, the most common acute fractures are compression fractures or vertebral endplate fractures caused by sudden axial loading, transverse process avulsion by the origin of the psoas muscle, spinous process avulsions, and acute fracture of the pars interarticularis from hyperextension.32

  • Vertebral body compression is more common in athletes with decreased bone density from a cause such as exercise-induced amenorrhea. In adolescents, endplate fractures (Schmorl node) or apophyseal avulsion fractures are relatively common. All these injuries are generally stable and heal with immobilization and nonsurgical management.
  • Spinous process fractures may occur as a result of direct trauma to the posterior spine or as a result of forcible flexion and rotation. These injuries are not usually associated with neurologic deficits. Violent muscular contraction or direct trauma can cause fractures of the transverse processes. For example, a football helmet blow to the back can cause fractures of both spinal and transverse processes. Despite their relatively innocuous appearance, these fractures can cause significant bleeding into the retroperitoneal space, resulting in acute anemia, or ileus.
  • Sports that cause frequent hyperextension of the lumbar spine induce stress on the pars interarticularis. A defect in the pars interarticularis or spondylolysis is common in competitors in sports that require repetitive or prolonged hyperextension of the spine, such as tennis (the serve), volleyball (the spike), and track (the high jump). Athletes with back pain and spondylolysis fall into 2 main groups, (1) those with acute or subacute lesions related to a precipitating episode of hyperextension or trauma and (2) those with well-established, chronic spondylolysis. Although each of the following lesions in isolation can appear benign, the spinal column must be evaluated further to rule out additional injury.
    • Female gymnasts have an incidence of pars defects 4 times greater than the general population. This is presumably the result of gymnastics maneuvers that load the spine in hyperextension (eg, dismounts, back walkovers, aerials).
    • Other athletes at higher risk for pars spondylolysis include ballet dancers, divers, and football linemen.
    • Thoracolumbar fractures have been estimated to occur in 14% of snowmobile injuries, 5% of alpine skiing injuries, and 8% of freestyle skiing injuries.
    • Direct trauma from hockey- or football-related injuries can also cause a fracture of an articular process.
  • Acute traumatic spondylolisthesis is usually associated with major trauma and is usually caused by extreme hyperextension. Although patients with a new fracture of the pars interarticularis may have a slip present at the time of the injury, a slip can occur months to years later as the disc degenerates under shear loads that it cannot sustain.

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Contents

Overview: Lumbosacral Spine Acute Bony Injuries
Differential Diagnoses & Workup: Lumbosacral Spine Acute Bony Injuries
Treatment & Medication: Lumbosacral Spine Acute Bony Injuries
Follow-up: Lumbosacral Spine Acute Bony Injuries
Multimedia: Lumbosacral Spine Acute Bony Injuries
[ CLOSE WINDOW ]

References

  1. Jones A, Andrews J, Shoaib A, et al. Avulsion of the L4 spinous process: an unusual injury in a professional rugby player: case report. Spine. Jun 1 2005;30(11):E323-5. [Medline].

  2. Tator CH, Provvidenza CF, Lapczak L, Carson J, Raymond D. Spinal injuries in Canadian ice hockey: documentation of injuries sustained from 1943-1999. Can J Neurol Sci. Nov 2004;31(4):460-6. [Medline].

  3. Hickey GJ, Fricker PA, McDonald WA. Injuries of young elite female basketball players over a six-year period. Clin J Sport Med. Oct 1997;7(4):252-6. [Medline].

  4. Halvorsen TM, Nilsson S, Nakstad PH. [Stress fractures. Spondylolysis and spondylolisthesis of the lumbar vertebrae among young athletes with back pain] [Norwegian]. Tidsskr Nor Laegeforen. Jun 30 1996;116(17):1999-2001. [Medline].

  5. Bennell KL, Malcolm SA, Thomas SA, et al. Risk factors for stress fractures in female track-and-field athletes: a retrospective analysis. Clin J Sport Med. Oct 1995;5(4):229-35. [Medline].

  6. Ekin JA, Sinaki M. Vertebral compression fractures sustained during golfing: report of three cases. Mayo Clin Proc. Jun 1993;68(6):566-70. [Medline].

  7. Razak M, Mahmud MM, Hyzan MY, Omar A. Short segment posterior instrumentation, reduction and fusion of unstable thoracolumbar burst fractures--a review of 26 cases. Med J Malaysia. Sep 2000;55 suppl C:9-13. [Medline].

  8. Stanislas MJ, Latham JM, Porter KM, Alpar EK, Stirling AJ. A high risk group for thoracolumbar fractures. Injury. Jan 1998;29(1):15-8. [Medline].

  9. Ryan M, Klein S, Bongard F. Missed injuries associated with spinal cord trauma. Am Surg. Jun 1993;59(6):371-4. [Medline].

  10. Williams B. Pathogenesis of post-traumatic syringomyelia. Br J Neurosurg. 1992;6(6):517-20. [Medline].

  11. Browne TD, Yost RP, McCarron RF. Lumbar ring apophyseal fracture in an adolescent weight lifter. A case report. Am J Sports Med. Sep-Oct 1990;18(5):533-5. [Medline].

  12. Alexander MJ. Biomechanical aspects of lumbar spine injuries in athletes: a review. Can J Appl Sport Sci. Mar 1985;10(1):1-20. [Medline].

  13. Snook GA. Injuries in intercollegiate wrestling. A 5-year study. Am J Sports Med. May-Jun 1982;10(3):142-4. [Medline].

  14. Konermann W, Sell S. [The spine--a problem area in high performance artistic gymnastics. A retrospective analysis of 24 former artistic gymnasts of the German A team] [German]. Sportverletz Sportschaden. Dec 1992;6(4):156-60. [Medline].

  15. Letts M, Smallman T, Afanasiev R, Gouw G. Fracture of the pars interarticularis in adolescent athletes: a clinical-biomechanical analysis. J Pediatr Orthop. Jan-Feb 1986;6(1):40-6. [Medline].

  16. Ciullo JV, Jackson DW. Pars interarticularis stress reaction, spondylolysis, and spondylolisthesis in gymnasts. Clin Sports Med. Jan 1985;4(1):95-110. [Medline].

  17. Tewes DP, Fischer DA, Quick DC, Zamberletti F, Powell J. Lumbar transverse process fractures in professional football players. Am J Sports Med. Jul-Aug 1995;23(4):507-9. [Medline].

  18. Saal JA. Common American football injuries. Sports Med. Aug 1991;12(2):132-47. [Medline].

  19. Virgin HW. Football injuries to the skeletal system. Compr Ther. Jan 1985;11(1):19-24. [Medline].

  20. Bowerman JW, McDonnell EJ. Radiology of athletic injuries: football. Radiology. Oct 1975;117(1):33-6. [Medline].

  21. Silver JR. Spinal injuries resulting from horse riding accidents. Spinal Cord. Jun 2002;40(6):264-71. [Medline]. [Full Text].

  22. Donald S, Chalmers D, Theis JC. Are snowboarders more likely to damage their spines than skiers? Lessons learned from a study of spinal injuries from the Otago skifields in New Zealand. N Z Med J. Jun 24 2005;118(1217):U1530. [Medline].

  23. Basu S, Makwana NK, Khazim R. Sledging related spinal injuries and fracture patterns: a report on five cases. Br J Sports Med. Oct 1999;33(5):357-8; discussion 359. [Medline]. [Full Text].

  24. Okamoto K, Doita M, Yoshikawa M, et al. Lumbar chance fracture in an adult snowboarder: unusual mechanism of a chance fracture. Spine. Jan 15 2005;30(2):E56-9. [Medline].

  25. Keene JS. Thoracolumbar fractures in winter sports. Clin Orthop Relat Res. Mar 1987;216:39-49. [Medline].

  26. Roberts VL, Noyes FR, Hubbard RP, McCabe J. Biomechanics of snowmobile spine injuries. J Biomech. Dec 1971;4(6):569-77. [Medline].

  27. Snook GA. A review of women's collegiate gymnastics. Clin Sports Med. Jan 1985;4(1):31-7. [Medline].

  28. Eismont FJ, Kitchel SH. Thoracolumbar spine. In: Delee JC, Drez D, eds. Orthopedic Sports Medicine: Principles and Practice. Vol 2. Philadelphia, Pa: WB Saunders Co; 1994:1018-62.

  29. Denis F. The three column spine and its significance in the classification of acute thoracolumbar spinal injuries. Spine. Nov-Dec 1983;8(8):817-31. [Medline].

  30. Denis F. Spinal instability as defined by the three-column spine concept in acute spinal trauma. Clin Orthop Relat Res. Oct 1984;189:65-76. [Medline].

  31. Magerl F, Aebi M, Gertzbein SD, Harms J, Nazarian S. A comprehensive classification of thoracic and lumbar injuries. Eur Spine J. 1994;3(4):184-201. [Medline].

  32. Rahme R, Moussa R. The modic vertebral endplate and marrow changes: pathologic significance and relation to low back pain and segmental instability of the lumbar spine. AJNR Am J Neuroradiol. May 2008;29(5):838-42. [Medline]. [Full Text].

  33. Lieberman JA, Lyon R, Feiner J, Hu SS, Berven SH. The efficacy of motor evoked potentials in fixed sagittal imbalance deformity correction surgery. Spine. Jun 1 2008;33(13):E414-24. [Medline].

  34. Lavelle WF, Lavelle ED, Smith HS. Interventional techniques for back pain. Clin Geriatr Med. May 2008;24(2):345-68, viii. [Medline].

  35. Korovessis P, Baikousis A, Zacharatos S, et al. Combined anterior plus posterior stabilization versus posterior short-segment instrumentation and fusion for mid-lumbar (L2-L4) burst fractures. Spine. Apr 15 2006;31(8):859-68. [Medline].

  36. Bailes JE Jr, Van der Veer CA. Surgical management of patients with sports-related spinal injuries. Clin Neurosurg. 2001;48:243-59. [Medline].

  37. Razak M, Mahmud M, Mokhtar SA, Omar A. Thoracolumbar fracture--dislocation results of surgical treatment. Med J Malaysia. Sep 2000;55 suppl C:14-7. [Medline].

  38. Denis F, Burkus JK. Shear fracture-dislocations of the thoracic and lumbar spine associated with forceful hyperextension (lumberjack paraplegia). Spine. Feb 1992;17(2):156-61. [Medline].

  39. Karjalainen M, Aho AJ, Katevuo K. Operative treatment of unstable thoracolumbar fractures by the posterior approach with the use of Williams plates or Harrington rods. Int Orthop. 1992;16(3):219-22. [Medline].

  40. Dai LY. Remodeling of the spinal canal after thoracolumbar burst fractures. Clin Orthop Relat Res. Jan 2001;382:119-23. [Medline].

  41. Denis F, Burkus JK. Diagnosis and treatment of cauda equina entrapment in the vertical lamina fracture of lumbar burst fractures. Spine. Aug 1991;16(8 suppl):S433-9. [Medline].

  42. Denis F, Burkus JK. Lateral distraction injuries to the thoracic and lumbar spine. A report of three cases. J Bone Joint Surg Am. Aug 1991;73(7):1049-53. [Medline]. [Full Text].

  43. Abel MS. Jogger's fracture and other stress fractures of the lumbo-sacral spine. Skeletal Radiol. 1985;13(3):221-7. [Medline].

  44. Aharony S, Milgrom C, Wolf T, et al. Magnetic resonance imaging showed no signs of overuse or permanent injury to the lumbar sacral spine during a Special Forces training course. Spine J. Jul-Aug 2008;8(4):578-83. [Medline].

  45. Benzel EC, Larson SJ. Postoperative stabilization of the posttraumatic thoracic and lumbar spine: a review of concepts and orthotic techniques. J Spinal Disord. Mar 1989;2(1):47-51. [Medline].

  46. Breitenfelder J. [Treatment of fractures of the vertebral body without involvement of the spinal cord or roots] [German]. Z Orthop Ihre Grenzgeb. Feb 1972;110(1):116-20. [Medline].

  47. Bötel U. [Classification and surgical indications in spinal injuries] [German]. Langenbecks Arch Chir Suppl Kongressbd. 1992;263-70. [Medline].

  48. Centenera LV, Choi S, Hirsch JA. Percutaneous vertebroplasty treats compression fractures. Diagn Imaging (San Franc). Nov 2000;22(11):147-8, 153. [Medline].

  49. Clark JE. Apophyseal fracture of the lumbar spine in adolescence. Orthop Rev. Jun 1991;20(6):512-6. [Medline].

  50. Commandre FA, Taillan B, Gagnerie F, et al. Spondylolysis and spondylolisthesis in young athletes: 28 cases. J Sports Med Phys Fitness. Mar 1988;28(1):104-7. [Medline].

  51. Csermely T, Halvax L, Schmidt E, et al. [Lower bone density (osteopenia) in adolescent girls with oligomenorrhea and secondary amenorrhea] [Hungarian]. Orv Hetil. Oct 26 1997;138(43):2735-41. [Medline].

  52. Dennis S, Watkins R, Landaker S, Dillin W, Springer D. Comparison of disc space heights after anterior lumbar interbody fusion. Spine. Aug 1989;14(8):876-8. [Medline].

  53. Ferrandez L, Usabiaga J, Curto JM, Alonso A, Martin F. Atypical multivertebral fracture due to hyperextension in an adolescent girl. A case report. Spine. Jun 1989;14(6):645-6. [Medline].

  54. Garth WP Jr, Van Patten PK. Fractures of the lumbar lamina with epidural hematoma simulating herniation of a disc. A case report. J Bone Joint Surg Am. Jun 1989;71(5):771-2. [Medline]. [Full Text].

  55. Greenan TJ. Diagnostic imaging of sports-related spinal disorders. Clin Sports Med. Jul 1993;12(3):487-505. [Medline].

  56. Hakalo J, Wronski J. [Complications of a transpedicular stabilization of thoraco-lumbar burst fractures] [Polish]. Neurol Neurochir Pol. Mar-Apr 2006;40(2):134-9. [Medline].

  57. Haussler KK, Stover SM. Stress fractures of the vertebral lamina and pelvis in Thoroughbred racehorses. Equine Vet J. Sep 1998;30(5):374-81. [Medline].

  58. Hopkins TJ, White AA 3rd. Rehabilitation of athletes following spine injury. Clin Sports Med. Jul 1993;12(3):603-19. [Medline].

  59. Hulkko A, Orava S. Diagnosis and treatment of delayed and non-union stress fractures in athletes. Ann Chir Gynaecol. 1991;80(2):177-84. [Medline].

  60. Jeanneret B, Gebhard JS, Magerl F. Transpedicular screw fixation of articular mass fracture-separation: results of an anatomical study and operative technique. J Spinal Disord. Jun 1994;7(3):222-9. [Medline].

  61. Kahler RJ, Knuckey NW, Davis S. Arachnoiditis ossificans and syringomyelia: a unique case report. J Clin Neurosci. Jan 2000;7(1):66-8. [Medline].

  62. Keynan O, Fisher CG, Vaccaro A, et al. Radiographic measurement parameters in thoracolumbar fractures: a systematic review and consensus statement of the Spine Trauma Study Group. Spine. Mar 1 2006;31(5):E156-65. [Medline].

  63. Knop C, Fabian HF, Bastian L, Blauth M. Late results of thoracolumbar fractures after posterior instrumentation and transpedicular bone grafting. Spine. Jan 1 2001;26(1):88-99. [Medline].

  64. Kösling S, Dietrich K, Steinecke R, Klöppel R, Schulz HG. Diagnostic value of 3D CT surface reconstruction in spinal fractures. Eur Radiol. 1997;7(1):61-4. [Medline].

  65. Levi AD, Hurlbert RJ, Anderson P, et al. Neurologic deterioration secondary to unrecognized spinal instability following trauma--a multicenter study. Spine. Feb 15 2006;31(4):451-8. [Medline].

  66. Massari L, Chiarelli GM, Lupi L, Bighi S. Fractures of the posterior apophyseal ring of the lumbar vertebral body in young patients. Three cases. [English, Italian]. Chir Organi Mov. Apr-Jun 1990;75(2):129-33. [Medline].

  67. Matejka J. [Hyperextension injuries of the thoracolumbar spine] [German]. Zentralbl Chir. Feb 2006;131(1):75-9. [Medline].

  68. Mazel C. [Spondylolisthesis in athletes] [French]. Presse Med. Apr 6 1991;20(13):596-600. [Medline].

  69. Moller A, Hasserius R, Besjakov J, Ohlin A, Karlsson M. Vertebral fractures in late adolescence: a 27 to 47-year follow-up. Eur Spine J. Aug 2006;15(8):1247-54. [Medline].

  70. Nabeshima Y, Iguchi T, Matsubara N, et al. Extension injury of the thoracolumbar spine. Spine. Jul 1 1997;22(13):1522-5; discussion 1525-6. [Medline].

  71. Parvataneni HK, Nicholas SJ, McCance SE. Bilateral pedicle stress fractures in a female athlete: case report and review of the literature. Spine. Jan 15 2004;29(2):E19-21. [Medline].

  72. Ryan PJ, Evans P, Blake GM, Fogeman I. The effect of vertebral collapse on spinal bone mineral density measurements in osteoporosis. Bone Miner. Sep 1992;18(3):267-72. [Medline].

  73. Ryan PJ, Fogelman I. Osteoporotic vertebral fractures: diagnosis with radiography and bone scintigraphy. Radiology. Mar 1994;190(3):669-72. [Medline]. [Full Text].

  74. Sicard A, Lavarde G. [Treatment of fractures of the thoracic and lumbar spine without neurological complications] [French]. Presse Med. Jan 4 1969;77(1):5-8. [Medline].

  75. Stavrev P. Thoracolumbar spine stabilization in fracture--dislocations. Folia Med (Plovdiv). 1994;36(4):59-65. [Medline].

  76. Teitz CC, Cook DM. Rehabilitation of neck and low back injuries. Clin Sports Med. Jul 1985;4(3):455-76. [Medline].

  77. Tschoeke SK, Hellmuth M, Hostmann A, et al. Apoptosis of human intervertebral discs after trauma compares to degenerated discs involving both receptor-mediated and mitochondrial-dependent pathways. J Orthop Res. Jul 2008;26(7):999-1006. [Medline].

  78. Van der Wall H, Magee M, Reiter L, Frater CJ, Qurashi S, Loneragan R. Degenerative spondylolysis: a concise report of scintigraphic observations. Rheumatology (Oxford). Feb 2006;45(2):209-11. [Medline]. [Full Text].

  79. Vollmer DG, Gegg C. Classification and acute management of thoracolumbar fractures. Neurosurg Clin N Am. Oct 1997;8(4):499-507. [Medline].

  80. Yoon SH, Miyazaki M, Hong SW, et al. A porcine model of intervertebral disc degeneration induced by annular injury characterized with magnetic resonance imaging and histopathological findings. Laboratory investigation. J Neurosurg Spine. May 2008;8(5):450-7. [Medline].

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Further Reading

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Keywords

lumbosacral spine acute bony injuries, lumbosacral fractures, sports-related spine fractures, spine fracture, broken back, lumbar spine injury, low back pain, LBP, back injuries, spine injuries, spinal injuries, paraplegia, quadriplegia, acute lumbar spine fracture, lumbar spine fracture, lumbosacral spine fracture, spinal cord injury

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Contributor Information and Disclosures

Author

Federico C Vinas, MD, Consulting Neurosurgeon, Department of Neurological Surgery, Halifax Medical Center
Federico C Vinas, MD is a member of the following medical societies: American Association of Neurological Surgeons, American College of Surgeons, American Medical Association, Congress of Neurological Surgeons, Florida Medical Association, and North American Spine Society
Disclosure: Nothing to disclose

Medical Editor

Andrew D Perron, MD, Residency Director, Department of Emergency Medicine, Maine Medical Center
Andrew D Perron, MD is a member of the following medical societies: American College of Emergency Physicians, American College of Sports Medicine, and Society for Academic Emergency Medicine
Disclosure: Nothing to disclose

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: Nothing to disclose

Managing Editor

Henry T Goitz, MD, Chief, Sports Medicine, Associate Professor, Department of Orthopaedic Surgery, Medical College of Ohio
Henry T Goitz, MD is a member of the following medical societies: American Academy of Orthopaedic Surgeons and American Orthopaedic Society for Sports Medicine
Disclosure: Nothing to disclose

CME Editor

Jon B Whitehurst, MD, Clinical Instructor of Surgery, University of Illinois College of Medicine; Partner and Executive Board Member, Rockford Orthopedic Associates; Orthopedic Chairman, Rockford Memorial Hospital
Jon B Whitehurst, MD is a member of the following medical societies: American Academy of Orthopaedic Surgeons, American Orthopaedic Society for Sports Medicine, and Arthroscopy Association of North America
Disclosure: Nothing to disclose

Chief Editor

Sherwin SW Ho, MD, Associate Professor, Department of Surgery, Section of Orthopedic Surgery and Rehabilitation Medicine, University of Chicago
Sherwin SW Ho, MD is a member of the following medical societies: American Academy of Orthopaedic Surgeons, American Orthopaedic Society for Sports Medicine, and Arthroscopy Association of North America
Disclosure: Nothing to disclose

 
 
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