Instabile Wirbelsäulenfraktur

An unstable spine fracture is a break in one or more spinal bones where the pieces no longer hold the spine in a safe, steady position, so movement can cause the bones to shift and threaten the spinal cord or nerves. This is more serious than a “stable” fracture and more often needs surgery or very strict protection.​

1) What is this condition?

  • A vertebra has broken in a way that lets it slip, tilt, or collapse more than normal when you move, instead of staying lined up with its neighbors.​

  • It often follows high‑energy trauma (car crash, fall from height, sports injury) or occurs in already weakened bone (severe osteoporosis, tumor).​

2) How serious is it?

  • Unstable fractures are considered serious because further movement can worsen the break and damage the spinal cord or nerves.​

  • Possible consequences include paralysis, loss of feeling, or loss of bladder and bowel control if the injury is not stabilized promptly.​

3) Non‑surgical treatments

  • Strict spine precautions at first: log‑rolling, avoiding bending/twisting, and keeping the neck or back in a brace as instructed.​

  • Bracing or casting (rigid neck collar or thoracolumbar brace) in selected cases where alignment is acceptable and nerves are not threatened.​

  • Pain medicines and gradual, supervised mobilization as allowed, often with a brace.​

  • These options are restricted to carefully chosen fractures; many unstable patterns go straight to surgery.​

4) Types of surgery that may be necessary

  • Spinal fusion with instrumentation: screws and rods placed above and below the fracture to hold the bones rigid while they heal together.​

  • Decompression plus fusion: removing bone fragments or disc pressing on the spinal cord or nerves, then stabilizing with screws, rods, and bone graft.​

  • Approaches can be from the back, front, or both (posterior, anterior, or combined), depending on level and fracture pattern.​

5) Goals of surgery vs non‑surgical care

  • Non‑surgical goals:

    • Protect the spine with bracing, allowing the fracture to heal without further shifting when surgery risk is high and the break can be held stable.​

    • Control pain and maintain as much safe mobility as possible while watching closely for any change in alignment or nerve function.​

  • Surgery goals:

    • Restore or maintain proper alignment and stop abnormal movement at the fracture level.​

    • Decompress the spinal cord and nerves if needed, to prevent or relieve paralysis, numbness, or severe nerve pain.​

6) How surgery can “fix” the problem

  • Screws are placed into solid vertebrae above and below the break, then connected with rods to hold the spine in a corrected position.​

  • Bone graft is placed so, over months, the treated levels grow together into one solid block, permanently stabilizing that part of the spine.​

  • When decompression is added, bone and fragments pressing on nerves are removed before the stabilization, creating both space and stability.​

7) Risks of surgery (general and specific)

  • General risks: infection, bleeding (sometimes substantial in big spine cases), blood clots, lung or heart complications, and anesthesia risks.​

  • Spine‑specific risks:

    • Nerve or spinal cord injury leading to new or worse weakness, numbness, or bladder/bowel problems.​

    • Hardware problems (screw loosening, rod breakage) or failure of the bones to fuse, sometimes needing another surgery.​

    • Increased stress on levels above and below the fusion, which can wear out faster over time.​

8) Chances this surgery will work

  • For unstable thoracic and lumbar fractures, instrumented fusion generally provides good mechanical stability and helps most patients sit, stand, and walk more safely.​

  • Surgery clearly reduces the risk of further displacement and late spinal deformity in truly unstable patterns, especially when there is nerve involvement or major misalignment.​

  • Long‑term pain and function vary and depend on injury severity, other injuries, age, and whether there was spinal cord damage before surgery.​

9) Possible complications from the surgery

  • Wound‑healing problems and infections, which are more common in large multi‑level fusions and trauma patients.​

  • Persistent pain, stiffness, or limited motion, even if the fusion is technically successful.​

  • Failure of fusion (nonunion) or progressive deformity around the fused area requiring revision surgery.​

10) Typical recovery from the condition

  • Without adequate stabilization, unstable fractures can lead to worsening deformity, chronic pain, and risk of delayed nerve injury.​

  • With proper bracing (in selected cases) and/or surgery, bone healing usually takes several months, with gradual improvement in pain and mobility.​

11) Typical recovery after surgery

  • Initial days: pain control, protection of the spine, and early assisted sitting and standing as allowed.​

  • Weeks to months: structured physical therapy to rebuild strength, balance, and endurance, with strict limits on bending, lifting, and twisting while fusion matures.​

  • Full fusion and maximum improvement often take 6–12 months; any spinal cord injury may recover only partially, depending on its initial severity.​

12) How long in the hospital

  • Many unstable spine fractures needing fusion require about 4–7 days in the hospital, longer if injuries are multiple or complications occur.​

  • Some patients go from hospital to inpatient rehab for intensive therapy before going home.​

13) Long‑term outlook

  • Patients without spinal cord damage can often return to independent life and even physical work, though heavy labor and high‑impact sports may be limited.​

  • Those with partial spinal cord injury may improve but can have lasting weakness, numbness, or bladder/bowel issues; rehab is key to maximizing independence.​

  • A fused segment remains stiff, and nearby levels may develop wear‑and‑tear over years, sometimes causing future pain.​

14) Need for outpatient follow‑up

  • Regular follow‑up visits with spine specialists to check healing, alignment, and hardware with X‑rays or CT scans.​

  • Ongoing physical and occupational therapy, and adjustment of braces and activity levels as recovery progresses.​

  • Long‑term monitoring for late deformity, adjacent‑level problems, or persistent nerve symptoms, with re‑evaluation if new pain, weakness, or bladder/bowel changes appear.