Thoracic Spine Trauma
Thoracic spine trauma is not uncommon in contact sports. It results from major (i.e., high-energy) injuries that involve large forces. Trauma to any part of the spine is very serious and needs to be looked at by an experienced chiropractor. Fracture to the thoracic spine (i.e., mid back) is common in cycling injuries, impact sports and motor accidents. It is suggested that neurological injury is involved in up to 25% of thoracic spine fractures.
Symptoms of thoracic spine trauma
Thoracic spine trauma involves an obvious mechanism such as a blow, crush or impact trauma. Small accidents can lead to thoracic spine fracture in osteoporotic vertebrae (i.e., spinal bones) or vertebrae weakened with neoplastic development (i.e., cancer). Pain is the most obvious symptoms with any trauma, especially in the spine. Your chiropractor will also do tests to look for sensitivity or pain along your vertebrae.
Fractures types due to thoracic spine trauma
Most thoracic spine fractures occur in the lower thoracic spine, with 60%-70% of thoracolumbar fractures occurring in the T11-L2 region, which is a biomechanically weak spot that undergoes a lot stress. The majority of these fractures occur without spinal cord injury. 20%-40% of the fractures are associated with neurologic injuries. High-energy trauma, is the most common cause of thoracic fractures. Minor trauma can also cause a thoracic spine fracture in individuals who have a condition associated with loss of bone mass (e.g., osteoporosis).
There are four major types (based on the mechanism of injury):
- Compression (wedge fractures). Caused by axial compression (i.e., vertical) alone or flexion forces, when the spine is bent forward or sideways at the moment of trauma. It is a stable fracture and patients rarely show neurologic deficits.
- Burst. Similar to compression, except that the entire vertebra is evenly crushed. It is a very severe fracture, accompanied with retropulsed bone fragments into spinal canal. Neurologic injury and posterior column injury can occur more frequently.
- Flexion-distraction (seatbelt injury/chance fracture). Involves the separation (i.e., distraction) of the fractured vertebra. It occurs by primary distractive forces on the spine. The axis of rotation is located within or in front of anterior vertebral body.
- Fracture-dislocation. Are found in combination with displacement of adjacent vertebrae. It is caused by various combinations of forces. It is very unstable and can cause complete neurologic deficit.
Characteristics of thoracic spine trauma
Over 65% of vertebral fractures are asymptomatic (i.e., the patient has no symptoms). They are sometimes found on X-ray when a patient is being screened for another injury.
Presentation of symptomatic fractures includes:
- Chronic back pain in thoracic and/or lumbar region
- Slower walking pattern (i.e., gait)
- Decreased range of motion
- Impaired pulmonary function (i.e., lungs)
- Increased kyphosis (i.e., increased mid back arch/curve) especially in osteoporotic patients with compression fractures
- Neurological deficits due to narrowing of spinal canal, which can present as long as 1.5 years after the injury
When patients have these symptoms for more than 3 months (i.e., chronic pain and dysfunction), it can lead to decreased physical function and performance of activities of daily living, and increased risk of disability.
Treatment of thoracic spine trauma
It goes without saying that a fracture is a medical emergency anywhere in the body, especially in the spine. The role of our chiropractors is to identify if someone presents with a fracture and refer on for further investigation and assistance. Sydney Spine & Sports Centre (S3C) is a back and neck pain centre of excellence. If our chiropractors suspect a fracture following trauma prompt referral is given. Once a medical clearance has been given and physical therapy is advised by specialists, our S3C chiropractors can play an important role in the rehabilitation of the patient’s thoracic spine trauma. The goals of conservative management of thoracic spine trauma include:
- Reduce pain
- Improve posture
- Improve thoracic mobility
- Strengthen trunk extensors
- Improve trunk control
- Provide education
- Lower extremity strengthening
Multimodal treatment approach over a 10-week period has been shown to successfully reduce pain and improve function in patients who suffered from osteoporotic vertebral fractures. Multimodal treatment may include soft tissue massage, postural taping, gentle spinal mobilisations, improving sitting posture, stretching and strengthening exercises and altering lifestyle risk factors.
Please visit our website for more information about spinal trauma:
- Mid and Upper back overview
- The effect of prolonged sitting on the neck and back
- Spinal stiffness: clinical relevance and management strategies
- When to worry about back pain
- Muscle pain
- Joint pain
- Thoracic myelopathy
- Thoracic spine trauma
- Thoracic osteophytes
- Thoracic bone Spurs
- Thoracic spine stenosis
- Thoracic degenerative disc disease
- Thoracic disc herniation
- Thoracic arthritis
- Thoracic foraminal stenosis
- Thoracic pinched nerve
- Thoracic facet syndrome
- Thoracic facet joint pain
- Thoracic disc bulge
- Thoracic disc protrusion
- Thoracic spondylosis
- Thoracic spondyloarthropathies
- Thoracic radiculopathy
- Thoracic discogenic pain
- Acute mid back pain
- Chronic mid back pain
- Stiff mid back
- Thoracic spine tumour
- Upper back arthritis