Spinal Fractures and Spinal Instability

Symptoms and warning signs

The first sign is usually pain at the level of the injury, in the back or the neck. It is worse on standing and eases when the person lies flat. In an older person with thin bones it can start after something as small as a cough or lifting a bucket, and is often mistaken for ordinary backache.

Some signs point to pressure on the nerves or spinal cord and need urgent attention: weakness or numbness in the legs, spreading pins and needles, difficulty walking, and any change in bladder or bowel control. A visible step in the back after an injury, or pain that wakes the person at night, should also be checked.

Causes and who is at risk

Road accidents and falls cause most spinal fractures in younger people. A motorbike crash or a fall from a roof can break a healthy vertebra outright, and such high-energy injuries often leave the spine unstable.

Osteoporotic compression fractures are different. In older people, especially women after the menopause, the bones slowly lose strength and a weakened vertebra can collapse under normal body weight. The bone becomes wedge-shaped and the person develops a stoop. A second fracture often follows the first if the bone thinning is not treated.

Spondylolisthesis is a slippage rather than a break. One vertebra, usually in the lower back, slides forward over the one below because of a bone defect or worn joints. The slip may stay mild for years or progress and pinch the nerves.

How it is diagnosed

Dr. Salman Falak starts with the story of the injury and a careful examination of the spine and nerves. An X-ray shows the shape of the vertebrae and any obvious slip. A CT scan shows the bone in detail: how the fracture is shaped and whether fragments are pushing back towards the spinal canal. An MRI shows the soft tissues, the discs, the ligaments, the spinal cord and the nerve roots, and whether any are bruised or compressed. In an older patient he may also ask for a bone density test. Together these answer the question that decides treatment: is the spine stable or not?

Treatment: a brace first, fixation when the spine is unstable

Many spinal fractures heal without an operation. If the vertebra has kept most of its height and nothing is pressing on the nerves, Dr. Salman Falak usually advises a brace and pain relief, with a slow return to walking. The brace holds the back still while the bone knits. Osteoporotic compression fractures are often managed this way, with treatment for the bone thinning added so the next vertebra does not collapse.

Fixation is needed when the spine cannot be trusted to hold itself: a vertebra that has lost much of its height, fragments in the spinal canal, a slip that is progressing or pinching nerves, or any injury with weakness or bladder changes. In these cases he performs transpedicular screw fixation. Screws are placed in the vertebrae above and below the injury and joined with rods, so the segment is held still while it heals. Where the anatomy allows, the screws go in through small cuts using minimally invasive spine surgery techniques, with less muscle damage and earlier walking.

What recovery looks like

With a brace, most patients are up and walking within days, and the bone heals over the following weeks to months. The brace comes off once X-rays confirm the fracture is solid, and bending and lifting are kept to a minimum until then.

After screw fixation, patients usually sit up and walk within a day or two with the physiotherapist, and go home once comfortable. Dr. Salman Falak gives clear rules on lifting and bending and relaxes them as the spine heals. Patients from Gujranwala or Faisalabad can do most of their follow-up by video, with fresh X-rays sent on WhatsApp.

When to see a neurosurgeon

Back or neck pain that starts after a fall or an accident should be checked before the person walks around on it. Do not wait if there is weakness or numbness in the legs or any trouble passing urine. In older people, sudden back pain that does not ease with rest, especially with known osteoporosis, deserves an X-ray rather than another course of painkillers. Anyone with known spondylolisthesis should see a neurosurgeon if the pain is spreading down the legs or walking distance is shrinking. Send the report on WhatsApp and Dr. Salman Falak will tell you whether you need to come in.

Related procedures and conditions

Fixation is one of several spine operations Dr. Salman Falak performs; the full range is on the spine surgery page. Long-standing pain after an old fracture or slip is covered under chronic back pain, and the small-cut approach to fixation is explained on the minimally invasive spine surgery page linked above.