Vertebral Burst Fracture

What it is

A burst fracture is a more severe break of a vertebra in which the bone is crushed and shatters outward, usually from a high-energy force like a fall from height or a car crash. Unlike a simple compression fracture, where the front of the bone wedges down, a burst fracture can push fragments of bone backward toward the spinal canal. It happens most often at the thoracolumbar junction, where the stiff upper back meets the mobile lower back.

What it feels like

There is usually significant back pain at the level of the break, often after a clear injury. If a fragment is pressing on the nerves or spinal cord, there may be numbness, weakness, or changes in bladder or bowel control — findings that raise the urgency considerably.

How we diagnose it

A CT scan shows the broken bone and any fragments in the canal in detail, and an MRI shows the spinal cord, nerves, and the ligaments that hold the spine together. Together they tell me how stable the fracture is and whether the nerves are at risk — the two questions that decide treatment.

How we treat it

Many stable burst fractures without nerve involvement heal well in a brace, with time and monitoring. Surgery is recommended when the fracture is unstable, the spine is bent out of alignment, or fragments are compressing the nerves or cord — in which case the operation relieves that pressure and stabilizes the spine so it can heal. We base the decision on stability and your neurological exam, not on the X-ray alone.

The science — for the curious

Two questions drive everything in a burst fracture: is the spine stable, and are the nerves being compressed? A stable fracture with a normal neurological exam often does not need surgery, because the spine can heal while a brace shares the load. When stability is lost or the cord is threatened, surgery protects the nervous system and restores a spine that can carry you safely — which is why the exam matters as much as the imaging.

Learn more

OrthoInfo — Fractures of the Thoracic and Lumbar Spine: orthoinfo.aaos.org

OrthoInfo — Osteoporosis and Spinal Fractures: orthoinfo.aaos.org

This handout is general education about a common condition and does not replace the personalized advice we discuss in clinic. If anything here does not match what we talked about, what we talked about wins — please ask me.