How and how well does a spinal fracture heal?

June 4, 2009 8:58 AM

If you have a spinal fracture, and it is treated immediately and properly, how well will it heal?

If you have an L5 wedge fracture treated with a brace, not surgery, what kind of life do you have afterward? Does it heal completely? How does it heal? What activities can you not do and why? Looking for life experience, medical input, pretty much any information on spinal fractures.

I understand that you are not a doctor or not our doctor. Our doctor is being extremely coy, as in, "You'll heal 100%, but no, you won't be able to do XYZ ever again." If you heal 100%, why are there limitations? We understand that no one can predict with certainty how someone will heal.

Any information would be helpful.

posted by clarkstonian to Health & Fitness (15 answers total)

In 2006 I was in a car accident and ended up with a crushed T9 vertabrae (sp?). I was in a "clamshell" brace for about 8 weeks anytime I had my spine at more than a 45 degree angle (i.e. I didn't have to wear the brace in bed). I did gentle excercise while in the brace and more when I got out of the brace. The injured part healed very well (aside from being exactly .5 inch shorter). I have no pain for the most part now--except occasionally and it seems to be caused by my now misshaped vertabrae slipping out of alignment and a quick trip to chiro (or even a good stretch) can pop it back into alignment.

I am now not limited in anyway and can do everything I did before except my golf swing isn't as good--not that I was a big golfer anyway.

I had more lingering effects from the head injury that went along with getting my back injured. (I was rear-ended on the freeway by a guy going 65 mph when everyone else had stopped--the seatback failed on my car and I slid out from under my seatbelt and slammed into the rear window frame). I am grateful everyday that I was not paralyzed.

Good luck with your recovery. I believe doing all the prescribed excercises helped with my getting back to normal as quickly as possible.
posted by agatha_magatha at 9:29 AM on June 4, 2009

I don't have a wedge fracture but I do have two fractured vertebrae (C7 and T1). The way my break is, the injury "healed" but the bones will never actually mend - I literally have pieces of bone floating around. Do they expect your bones to heal? Or are you just going to do enough physical therapy that the muscles heal up around the injury to support the bone?
posted by radioamy at 9:31 AM on June 4, 2009

Years ago my dad was on a ladder that collapsed, and he landed with his knees locked. Being the type of guy that he was*, he refused to go to the doctor. He was noticeably 2 inches shorter, and in pain for a couple months. Five years later, he injured himself again and my mom forced him to go to the emergency room. In the various x-rays and scans, they noticed that he had 2 healed fractures in his spine and a disc that had been completely crushed from the incident 5 years prior.

So with zero medical supervision he healed multiple spinal fractures and continued to work cutting down trees for years. I realize that's not quite the same as your situation, but at least it shows that it is possible to go back to 100% without surgery (just some advil).

*Yes, he was crazy, and had an incredible pain tolerance.
posted by thejanna at 9:55 AM on June 4, 2009

I think you're missing the point. Spinal fractures, by themselves, tend to heal as well as any bone breakage. Which is to say, "Decently, but the odds of some form of permanent injury are real." Because we're talking about the spine, the effects of a permanent injury are likely to be more pronounced than, say, breaking your forearm. It could affect height, gait, and use of limbs. But there really is just a kind of "wait and see" thing going on, as is the case with any bone injury. Our bodies ain't pefect.

But that's not the real question here. For spinal injuries, the real question is how much the nerves in the spinal column have been damaged, because there really isn't any way of predicting how well those will heal. If it's just a bruise, function can be completely lost, but then completely restored. If it's cut, well, you're hosed. But there's a spectrum of injuries between there, and function can be any of totally, partially, or not at all restored, and telling them apart is really difficult. There really isn't any way of discerning a temporary bruise from a minute but final severing without doing risky surgery. So if there's some loss of function, the doctor really can't make any promises as to how you're going to recover. Nerve injuries are strange, and they don't heal like other tissues do.
posted by valkyryn at 10:04 AM on June 4, 2009

Response by poster: This is all helpful. It helps to explain why they can't give us more information.

One issue with a wedge fracture is, it tends to pitch the body forward (i.e. at this low break, the back would normally heal forcing the body into a permanent bent-over position with the head facing the ground. The shell and leg brace are designed to help prevent that - but will the bone grow in around that wedge to fill in, or will that vertebrae always be triangular? If so, will the spine, over time, tend to tilt forward?

I am not the one with the fracture, and I cannot ask these questions in front of the dr. with the actual patient there.
posted by clarkstonian at 10:31 AM on June 4, 2009

Your doctor is being coy because he has to play it safe. He has to play it safe because it is impossible to give you hard and fast answers when it comes to nerve damage.

IANYNeurosurgeon, but my grandfather was one, and if there's anything I gleaned from him, it was that every. single. case. was unique. He may have a patient with a fracture that looks exactly like the same one he saw last week, in the same place, with almost completely different outcomes. When it comes to neurology, it is much harder than the other veins of medicine to give reasoned, reliable projections of the outcome.

Now, take my broken wrist for example (I've broken both twice, so I'm pretty familiar). You don't have to factor in a spinal cord, delicately encased inside those bones, so its pretty damn easy for the doctor to tell me about how exactly long its going to take it to heal, and what I will and will not be able to do, and when. Neurology just isn't nearly that simple - sucks, but there you are.

If your Neuro says "no, you'll never be able to run again," and he's right, well, safe diagnosis.

If he says "no, you'll never be able to run again," but by some miracle you recover to the point that you can - you'll be too busy running to stop to think "I should sue that damn doctor for telling me I'd never run again."

If he says "you'll heal up just fine and be running in no time..." well, I think you follow me. Its in the doctor's best interests to hedge his bets.

So, that's not a life experience from the "I had a spinal fracture" perspective, but more from the doc's perspective. If you think he's just not being frank enough, you might consider investing in a second opinion.
posted by allkindsoftime at 10:48 AM on June 4, 2009

I don't have much to offer, besides how muscle tension persisted for a couple of years after my spinal injury and I think it was because I was afraid to move naturally even after getting the all clear, which consisted of "Okay. Healed. Don't need to see you any more." My brain stayed in OMG! spine! mode for a long time. I wish I'd gotten some advice- any advice- about when to stop doing something or what to watch out for.

I don't remember exactly which L was injured but I don't twist repetitively- gets me out of raking leaves and sweeping. Slight bends held for any length of time hurt- feels like it locks in place for a few minutes. Sometimes my thigh will briefly go numb to the knee with extended walking time. Sometimes it takes a moment to get out of bed if I've been sleeping deeply. I'm happy to be able to feel these things, as it could have been a much more traumatic injury.

Also, I recently got on the table to humor my husband and his chiropractor -no work! don't like pops!- and he zeroed in on the same two areas that were injured 27 years ago.

I hope the healing goes well.
posted by auntbunny at 11:09 AM on June 4, 2009

clarkstonianPoster: "I cannot ask these questions in front of the dr. with the actual patient there."

Can you make an appointment with the doctor when she isn't there, to discuss these issues?
posted by The corpse in the library at 12:10 PM on June 4, 2009 [1 favorite]

Can you make an appointment with the doctor when she isn't there, to discuss these issues?
I'm pretty sure that would be a violation of medical ethics on the doctor's part.
posted by pointless_incessant_barking at 12:22 PM on June 4, 2009

I have a compound fracture on my L1 due to a fall out of a window 6 years ago. I had to wear a brace for 8 weeks or so and could only take it off to sleep or move no more than 30 degrees. I have made a "full recovery" as far as the Dr's are concerned. I am quite active and ride my bike almost everywhere. I do get stiff a lot easier than I used to and have to take frequent breaks if I am doing work that causes me to be bent over (gardening comes to mind). This year I took some proactive steps, after I realized I was getting much more stiff and having more pain in my back. I found a physical therapist who prescribed, initially, stretches for my back and legs to improve my flexibility and then a series of low impact exercises to strengthen my core. After 2 weeks it was like night and day in regard to pain and stiffness. I have found that my quality of life is much better after working on strengthening my core. I also realized my physical therapy after the injury was mostly about getting back to "normal" (putting on my shoes, getting out of bed, regaining strength I had lost while in the brace), but there is still more work that can be done after that point to keep yourself strong.

FWIW folks are very surprised to learn that I had a very serious and traumatic accident and can still do what I do (everyday things) and be active like I am (by no means a jock in any stretch of the imagination). Good luck!
posted by Asbestos McPinto at 12:47 PM on June 4, 2009

I should also mention that my bones have fused and healed completely, which makes a big difference in regards to strength and stability.
posted by Asbestos McPinto at 12:53 PM on June 4, 2009

Wow, there's so much randomness when it comes to spinal injuries.

You can "heal 100%", as in the fractures are all fused, but with some underlying structural weakness that allows one to walk and move just fine, but precludes something like playing pro football.

There are also issues of what scar tissue can do. And, of course, there's the possibility that it's the doctor's opinion that you never should have been doing XYZ in the first place, and the injury sort of proves that.

Second and third opinions are a really good idea here. Bring along all your imaging - from the original diagnosis onward.
posted by Citrus at 1:03 PM on June 4, 2009

Not the same injury, but for some data points: I had a compression fracture of the sacrum a few years ago. My fracture line was vertical, not horizontal, so my height wasn't affected, just the side-to-side alignment of my pelvis & spine- I have slight, helix-shaped scoliosis now.

In my case, the bone seemed to heal well (although I guess we'll really see how well when I have a baby in a few years and those joints are expected to move). But the ligaments in my lumbar spine were stretched out & hyper-extended, and now I am much more swaybacked, and as a result, quite prone to lower back pain. It doesn't help that I sit on my bed with a laptop all day. Your friend will probably gain a lot from investing in a good desk chair. I try to mind my posture when walking and standing, but sitting involves internet and that makes me slouch.

Yoga helps a lot, especially child's pose, upward dog, and whatever this pose is called. I started yoga as soon as I could post-injury; about 4 months after, maybe, and I could do back bends again (after not doing one since adolescence) within just a couple months.

Also, I was surprised to notice that short amounts of running and high-impact stuff like skipping- just for 5-15 minutes at a time- make my back feel a lot better, too. My layman's rationale for this is that I'm re-distributing the fluid in my discs....? I dunno, but it works. I don't push it, though- no marathons for me, just around the park a few times. I also like to stretch by sitting & lying back on one of these big annoying balls (click that link!).
posted by pseudostrabismus at 3:10 PM on June 4, 2009

I should add: but, in general, I'm very healthy, take no pain medication, and am active. You'd never know I'd had an injury if I didn't tell you. My back pain at this point is largely my fault (slouching for hours) and at some point I'll develop better habits w/ posture & exercise, to control it.
posted by pseudostrabismus at 3:12 PM on June 4, 2009

Response by poster: This is all very helpful. I do understand that we are all different, and we all heal differently, but it's good to hear how well people have healed from various traumatic injuries. I'm making a collection of all of the recommendations, with the understanding that some won't work, but some might, and some are things we wouldn't think to try. Thanks!
posted by clarkstonian at 4:52 PM on June 4, 2009