Adult vertebral fractures

Spinal fractures are a frequent and sometimes challenging clinical problem. Patients with unstable injuries are usually best treated by early stabilization, while those patients with a stable injury, and no significant deformity or neurological deficit are usually treated conservatively. The treatment of patients with potential instability, late deformity or sometimes neurological deficit remains challenging. Multiple spine classification systems are in existence, in an attempt to assess stability and provide guidelines for treatment. Understanding spinal stability is vital in the management of these cases. The goals of treatment for spinal fractures are to restore function, maintain stability and alignment and to prevent late complications with minimal risk to the patient. Fracture patterns, classification and treatment vary among the parts of the vertebral column and are broadly divided into upper cervical spine, subaxial cervical spine and thoracolumbar spine. Osteoporosis and ankylosing spondylitis may cause different injury patterns. In osteoporosis, low-energy fractures are often seen. Ankylosing spondylitis leads to significant changes in spine biomechanics and thus frequent and atypical fractures may be seen. These patients must be managed with expert input due to the complex issues surrounding these fractures. In this article we discuss the assessment, the mechanisms of injury, spinal stability and the concepts contributing to this, and the specific fracture types and their treatment.