Spinal fractures in adults

Spinal fractures are an important clinical problem. It is widely accepted that patients with very unstable injuries are best treated by early instrumented fusion. It is clear that patients with stable injuries and no significant deformity or neurological defect are best treated conservatively. The treatment of patients with mild deformity, instability or neurological deficit remains rather controversial. Numerous classification schemes for spinal fractures have been published over the past 40 years. Perhaps this indicates that we are still looking for an ideal classification. An understanding of the concepts that underpin the published classification systems is useful for all staff involved in the initial management of these cases. In this article we discuss mechanism of injury, the concept of stability, including the theories of spinal columns, and the assessment of neurological injury. Conditions such as osteoporosis and ankylosing spondylitis significantly affect the conditions under which spinal injury may occur and alter the type of injury sustained. These conditions also alter the surgical decision-making process. The goals of treatment for spinal fractures are the same as for any other musculoskeletal injury: to save life (and limb), preserve function, prevent pain and promote rehabilitation.