Spinal Fracture-Dislocation

A spinal fracture‑dislocation is a severe spine injury where one or more vertebrae are both broken and knocked out of alignment, so the bones are no longer stacked properly and can easily move and damage the spinal cord or nerves. It almost always comes from high‑energy trauma (car crash, fall from height, crush injury) and is usually considered an emergency.

1) What is this condition?

One or more spinal bones are fractured and at the same time shifted or twisted out of place relative to each other.
Because of the combined break and shift, the spinal canal can become very narrow, putting the spinal cord and nerve roots at high risk.

2) How serious is it?

These injuries are “highly unstable” and often cause serious spinal cord or nerve damage, including paralysis and loss of bladder/bowel control.
Even when nerve function is initially preserved, there is a strong risk that further movement can cause sudden neurologic injury without prompt stabilization.

3) Non‑surgical treatments

Immediate immobilization (neck collar, spine board, careful log‑rolling) and hospital care to prevent any further movement.
For true fracture‑dislocations, non‑surgical treatment alone is rarely appropriate; traction or bracing may be used only temporarily while preparing for surgery.
Pain control, treatment of other injuries, and early intensive care support are critical while the spine is being evaluated.

4) Types of surgery that may be necessary

Emergency or urgent reduction and stabilization:
- Decompression to remove bone fragments or disc pushing on the spinal cord or nerves.
- Instrumented fusion with screws, rods, and bone graft to realign and hold the vertebrae rigidly while they heal.
Surgery may be done from the back, front, or both, depending on which parts of the spine are damaged.

5) Goals of surgery vs non‑surgical care

Non‑surgical goals:
- Prevent any further motion or damage while rapidly assessing the injury and preparing for surgery.
- Stabilize the patient’s overall condition (breathing, blood pressure, other injuries).
Surgery goals:
- Realign the spine, protect or decompress the spinal cord and nerves, and create a stable construct so the spine cannot shift again.
- Enable earlier, safer mobilization and rehabilitation.

6) How surgery can “fix” the problem

Surgeons gently reposition (reduce) the dislocated vertebrae into their proper alignment and remove any bone fragments or disc material squashing the cord or nerves.
Screws are placed into solid vertebrae above and below the injury and connected with rods; bone grafts are added so, over months, the bones fuse into a solid bridge across the injured segment.
This combination of decompression and fusion restores a more normal canal shape and prevents further dangerous movement at the injured level.

7) Risks of surgery (general and specific)

General risks: infection, bleeding (often significant in large trauma cases), blood clots, lung or heart complications, and anesthesia risks.
Spine‑specific:
- Worsening of neurologic status if the spinal cord or nerves are further injured during reduction or hardware placement.
- Hardware failure, non‑fusion, or progressive deformity, sometimes needing revision surgery.

8) Chances this surgery will work

Early realignment and stabilization are considered essential in fracture‑dislocations and can prevent secondary neurologic injury and allow better rehab.
Neurologic recovery depends mainly on the initial injury: studies show incomplete cord injuries improve in a majority (around two‑thirds), while complete injuries improve far less often.
Even when paralysis does not fully recover, surgery typically succeeds in stabilizing the spine and reducing mechanical pain.

9) Possible complications from the surgery

Wound infection or breakdown, especially in multi‑level fusions and polytrauma patients.
Persistent pain, stiffness, and limited range of motion around the fused area.
Long‑term issues like adjacent‑level wear‑and‑tear or progressive deformity above or below the fusion construct.

10) Typical recovery from the condition

Without adequate stabilization, fracture‑dislocations can lead to worsening deformity, chronic pain, and delayed spinal cord injury.
With prompt surgery and rehab, many patients regain a degree of independence, though the level of recovery depends on the original spinal cord damage and associated injuries.

11) Typical recovery after surgery

Initial days: intensive monitoring, pain control, and strict spine precautions, followed by gradual sitting and standing with support as allowed.
Weeks to months: structured inpatient and then outpatient rehab focused on mobility (with or without aids or wheelchair), self‑care, and strength.
Bone fusion and maximal functional recovery often take 6–12 months; neurologic gains, if any, are usually fastest in the first year.

12) How long in the hospital

Many patients with fracture‑dislocation and/or spinal cord injury require 1–2 weeks or more in acute hospital care, depending on other injuries and complications.
This is often followed by several weeks to months in a rehabilitation facility.

13) Long‑term outlook

Patients without cord damage at the start can often return to a high level of function if the spine is well stabilized.
Those with incomplete spinal cord injury frequently improve, sometimes enough to walk with aids, while complete injuries usually have limited neurologic recovery.
Chronic pain, spasticity, bladder/bowel changes, and the psychological impact of trauma often require long‑term management.

14) Need for outpatient follow‑up

Regular follow‑up with spine surgeons to monitor fusion, hardware, and alignment with X‑rays/CT, especially in the first 1–2 years.
Ongoing rehabilitation medicine, physical and occupational therapy, and, when needed, urology and pain‑management follow‑up.
Lifelong monitoring for late complications (adjacent‑level degeneration, deformity progression, hardware issues) and for changes in neurologic status.