From the Guidelines
Lumbar fractures typically present with localized back pain that worsens with movement, especially bending or twisting, and can be accompanied by neurological symptoms such as numbness, tingling, or weakness in the legs if the fracture compresses spinal nerves. Patients often report immediate pain following trauma such as a fall, car accident, or sports injury 1. The pain may radiate to the buttocks or legs, and patients might experience muscle spasms, limited mobility, and tenderness over the fracture site. Some patients may develop visible deformity or bruising in the lower back area. The severity of symptoms depends on the fracture type, with compression fractures often causing milder symptoms than burst or chance fractures. Elderly patients with osteoporosis may develop compression fractures with minimal trauma or even during routine activities.
Key Symptoms and Presentation
- Localized back pain that worsens with movement
- Neurological symptoms such as numbness, tingling, or weakness in the legs
- Muscle spasms and limited mobility
- Tenderness over the fracture site
- Visible deformity or bruising in the lower back area
Importance of Prompt Medical Attention
Prompt medical attention is essential for any suspected lumbar fracture to prevent potential complications like spinal instability or neurological damage 1. Diagnosis typically requires imaging studies such as X-rays, CT scans, or MRI to confirm the fracture and assess its stability and impact on surrounding neural structures.
Management and Treatment
The management of lumbar fractures involves a thorough medical evaluation, including assessment of any neurologic deficits, and imaging of the affected spinal segment to characterize the fracture and determine the extent of disease 1. The treatment approach may vary depending on the type and severity of the fracture, as well as the presence of any underlying conditions such as osteoporosis or metastatic disease.
From the Research
Presentation of Lumbar Fractures
- Lumbar fractures can present with abrupt-onset low back pain with or without a history of trauma 2
- More than two-thirds of vertebral compression fractures are detected incidentally 2
- Spondylolysis, a common cause of lower back pain in pediatric and adolescent populations, can present with lower back pain, particularly in young sporting individuals 3
Diagnostic Evaluation
- Plain radiography remains a mainstay in the diagnostic evaluation of low-energy trauma patients 4
- Computed tomography (CT) exhibits its unsurpassed power in polytrauma and plays a decisive role in all equivocal cases where the osseous situation is unclear 4
- Magnetic resonance imaging (MRI) is increasingly gaining importance for assessing both discoligamentous integrity and intraspinal condition 4, 2, 3
- MRI is also the modality of choice to determine if the fracture is acute vs chronic in nature 2
Fracture Classification
- The AOSpine classification system is used to classify thoracolumbar spine fractures, which includes both neurological criteria and clinical modifiers 4
- Three main types of fractures are distinguished based on stability: A, B, and C-type spinal injuries, with C-type injuries considered unstable 4
- Special fracture patterns of the injured ankylosed and osteoporotic spine as well as of the pediatric lumbar spine are discussed 4
Risk Factors and Prediction
- CT-based bone density and strength measurements from the thoracic spine predict incident vertebral fracture as well as measures from the lumbar spine 5
- Bone measurements from T8 and L2 predict incident vertebral fracture equally well, regardless of fracture location 5
- CT-based bone density and strength measurements from the thoracic spine may be useful for identifying individuals at high risk for vertebral fracture 5