A spinal fracture is a break in one or more bones of the spine, and whether it needs surgery depends mainly on whether the spine is stable and whether the spinal cord or nerves are injured. Many stable fractures heal with pain relief, a brace and careful mobilisation, while unstable fractures or those pressing on the spinal cord usually need surgery to fix the spine and protect the nerves.
In Lahore and across Pakistan, spinal fractures most often follow road traffic accidents (especially motorcycle crashes), falls from roofs, ladders and construction sites, and, in older people, a minor fall onto weak, osteoporotic bones. This page explains what to do at the scene, how fractures are assessed, and what treatment and recovery involve.
How a patient is handled in the first minutes can matter a great deal. Suspect a spine injury after any serious accident or fall, especially if the person has neck or back pain, numbness, tingling or weakness, or is unconscious.
Even if the person can walk, a significant accident followed by back or neck pain should be checked in an emergency department.
These result from high-energy injuries such as road accidents and falls from height. They include compression fractures (the front of the bone is squashed), burst fractures (the bone breaks into pieces, which can push into the spinal canal), and fracture-dislocations (the spine is broken and shifted, often with spinal cord injury).
In older people, especially women after menopause and those on long-term steroids, bones can become weak enough to collapse with a minor fall, lifting something, or even coughing. The main symptom is sudden back pain, often in the mid-back. Several such fractures can cause loss of height and a stooped posture. These are often missed, so new back pain in an older person deserves an X-ray.
Less commonly, a vertebra breaks because it is weakened by infection such as spinal tuberculosis or by a tumour. These need specific investigation and treatment.
This is the most important question in treatment. A stable fracture is unlikely to shift further or damage the nerves, and the spine can usually carry weight safely with or without a brace. An unstable fracture involves damage to several parts of the spine, such as the back ligaments and bony structures, so the bones may move and injure the spinal cord. Unstable fractures usually need surgical fixation.
When fracture fragments or misalignment press on or damage the spinal cord or nerves, symptoms can include:
The injury may be complete (no movement or feeling below the level) or incomplete (some function remains). Patients with incomplete injuries generally have more potential for recovery. Early specialist care aims to prevent further damage, though existing cord damage cannot always be reversed.
Many stable fractures, including most osteoporotic compression fractures and some stable traumatic fractures without nerve injury, are treated non-surgically:
Surgery is usually considered for unstable fractures, spinal cord or nerve compression, worsening deformity, or pain that does not settle.
Screws are placed into healthy vertebrae above and below the fracture and joined with rods to hold the spine in the correct position while it heals. In suitable cases this can be done through small incisions using minimally invasive spinal fixation, which may reduce muscle damage and help earlier mobilisation.
If bone fragments are pressing on the spinal cord or nerves, they are removed to free the nerves, usually combined with fixation. Where the cord is compressed, surgery is generally planned as early as safely possible.
For some painful osteoporotic compression fractures that do not settle with conservative care, medical bone cement can be injected into the broken vertebra through a needle. In kyphoplasty, a small balloon is first used to create space. These are selected treatments and are not suitable for every fracture.
Fractures can also leave a vertebra slipped out of line, similar to spondylolisthesis, and may need fusion. For other procedures, see our spine surgery page.
Risks include infection, bleeding, nerve or spinal cord injury, screw loosening (more likely in weak bones), failure of fusion, blood clots and chest complications. Trauma patients may have other injuries that affect timing and safety. Benefits and risks are discussed with the patient and family.
Head and brain injuries often occur together with spinal fractures; see our neurosurgery page for the wider range of conditions treated.
No. Many stable fractures heal with a brace, pain relief and physiotherapy. Surgery is mainly for unstable fractures, nerve or spinal cord compression, or worsening deformity.
Yes, this is a common pattern for an osteoporotic compression fracture. She should have an X-ray. Most of these are treated without surgery, along with osteoporosis treatment.
This depends on how severe and complete the injury is. Patients with incomplete injuries have a better chance of regaining function. Early surgery to decompress and stabilise, followed by rehabilitation, gives the best opportunity for whatever recovery is possible.
Usually not. They are often left in permanently, though removal is considered in some younger patients after healing or if they cause problems.
For a new injury with weakness or numbness, go to an emergency department. For a known fracture or follow-up, bring your CT and MRI scans and book an appointment.
Dr. Khawar Anwar is a Consultant Neurosurgeon & Spine Surgeon at PINS / Lahore General Hospital, Lahore, with over 10 years of experience in brain and spine surgery. He sees patients in Lahore and Gujranwala and focuses on minimally invasive and endoscopic techniques where they are suitable for the patient.
See the full list on the certifications page or read more about Dr. Khawar Anwar.
See all clinics, maps and timings on the locations page.
To book, call or WhatsApp 0333-7574732 and tell us which clinic and day suits you. Please bring your MRI or CT scan (films and CD), reports and a list of your current medicines to the consultation. For sudden weakness, loss of bladder or bowel control, a sudden severe headache or a head or spine injury, go to the nearest emergency department first.