Spinal Fractures: When Surgery Is Needed and What Recovery Looks Like

Trauma, Fractures & Emergencies · Reviewed by Lekhaj Daggubati, MD

A spinal fracture is a break in one of the vertebrae. Some are minor injuries that heal in a brace; others threaten the spinal cord and need surgery within hours. What separates them is stability — whether the spine can still protect the nerves and hold its shape under load — and whether the nerves are already injured. Dr. Daggubati treats spinal fractures across the region’s emergency departments and trauma centers, and follows patients through recovery whether or not they need an operation.

Most fractures fall into two groups. In younger patients they follow high-energy trauma: falls from height, motor vehicle collisions, sports. In older patients, osteoporosis means a vertebra can collapse from a minor fall or even a cough. The two groups are treated differently, and this page covers both.

Symptoms

Sudden, severe back or neck pain after a fall, collision or lifting
Pain that is worse standing or walking and better lying flat
Numbness, tingling or weakness in the arms or legs
Difficulty walking or loss of balance
Loss of bladder or bowel control (an emergency)
In osteoporosis: a gradual loss of height or a new stoop

How it is diagnosed

CT is the best test for the bone and shows the fracture pattern precisely. MRI shows the ligaments, the discs and the spinal cord, and is needed when there is any neurological symptom or when the CT suggests the injury may be unstable. Standing X-rays are added once the patient is safely upright to see how the spine behaves under load. A DEXA scan and blood work identify osteoporosis so it can be treated after the fracture heals.

When to seek urgent care

After any significant fall or accident, new weakness, numbness, difficulty walking, or loss of bladder or bowel control means the spinal cord or nerves may be injured. Call 911 or go directly to an emergency department; do not wait for an office visit.

Treatment options

Without surgery

Most stable fractures are treated without surgery: a period of bracing (typically 6–12 weeks), pain control, early walking, physical therapy, and repeat X-rays to confirm the spine is not collapsing further. Osteoporosis is treated at the same time to protect the rest of the spine.

Surgical options Dr. Daggubati offers

Thoracolumbar fractures

The junction between the rigid thoracic spine and the mobile lumbar spine (T11–L2) absorbs most of the force in a fall or collision, so it is where most fractures occur. The main patterns are:

Compression fracture: the front of the vertebra crushes while the back stays intact. Usually stable and treated in a brace.
Burst fracture: the whole vertebral body shatters and bone can push backward into the canal. Stable burst fractures without neurological symptoms can often be braced; those with canal compromise, deformity or nerve injury need surgery.
Flexion-distraction (Chance) fracture: the spine is pulled apart from the back, tearing the posterior ligaments — classically a seat-belt injury. These are unstable and usually need fusion.
Fracture-dislocation: the vertebrae have shifted on one another. Always unstable, frequently with cord injury, always surgical.

Cervical fractures

Neck fractures range from minor bony chips to injuries that threaten the spinal cord. Common patterns include fractures of the odontoid (the peg of C2, especially in older adults after a fall), the C1 ring (Jefferson fracture), and facet fractures or dislocations from flexion injuries, which can lock the neck out of alignment and pinch the cord. The neck has less room around the spinal cord than the lower back, so cervical injuries are managed with a lower threshold for MRI, for a hard collar, and for surgery when instability is present. Some fractures, such as odontoid fractures in the elderly, are commonly treated in a collar; others, such as facet dislocations, need urgent realignment and fusion.

How we decide on surgery: the scoring systems

Neurosurgeons use two validated scoring systems to make the decision consistent and transparent. The TLICS score (Thoracolumbar Injury Classification and Severity) and its cervical counterpart, SLICS, each add three things:

Fracture pattern: compression (1 point), burst (2), rotation or translation (3), distraction (4).
The posterior ligaments that hold the spine together: intact (0), suspected injury (2), definitely torn (3).
Neurological status: normal (0), a single nerve root (2), complete cord injury (2), incomplete cord injury or cauda equina (3).

A total of 3 or less is treated without surgery; 5 or more is treated with surgery; a score of 4 is a judgment call made with the patient, weighing age, bone quality, other injuries and the deformity. These scores are a framework, not a rule: the shape of the spine, the risk of progressive collapse, and the patient’s own goals all enter the decision, and Dr. Daggubati walks through the reasoning with every patient and family.

The role of decompression and fusion

Surgery for a fracture does two separate jobs, and not every fracture needs both. Decompression removes bone or disc fragments that are pressing on the spinal cord or nerve roots; it is done when there is a neurological deficit or a large amount of bone in the canal. Fusion restores stability: screws and rods hold the injured segment in alignment while bone graft heals it into one solid unit. Whenever the injury allows, stabilization is done percutaneously — screws placed through small incisions with navigation — which spares the back muscles and shortens the hospital stay. For many burst fractures without cord compression, the fracture is realigned and held from behind without opening the canal at all. In selected young patients with stable healing, hardware can be removed once the bone has healed, returning motion to the segment.

The role of kyphoplasty

Kyphoplasty is not a treatment for unstable or traumatic fractures. It is a targeted procedure for one specific problem: a painful osteoporotic (or cancer-related) compression fracture that has not settled with a few weeks of conservative care. Through a needle the width of a pencil, a small balloon lifts the collapsed bone and the cavity is filled with bone cement, stabilizing the fracture from the inside. Pain relief is often immediate, the procedure takes about 30 minutes under sedation, and patients go home the same day.

It is appropriate when the posterior wall of the vertebra is intact, there is no neurological deficit, the fracture is recent (typically under three months, with edema on MRI), and pain limits walking or standing despite bracing and medication. It is not used for burst fractures, fractures with canal compromise, or fractures that are already healed. Treating the underlying osteoporosis afterward matters as much as the procedure: about one in five patients will have another compression fracture within a year without it.

Expected recovery

Stable fracture treated in a brace: pain improves steadily over 4–6 weeks; the brace is worn for 6–12 weeks with X-rays at intervals; walking is encouraged from the first days; most people return to desk work within 2–4 weeks and full activity by three months.
Kyphoplasty: home the same day, often with immediate pain relief; walking right away; return to normal activity within days; no brace.
Percutaneous stabilization: 1–3 nights in hospital; walking the next day; lifting restrictions for 6–12 weeks; bone healing over 3–6 months.
Decompression and fusion: 2–5 nights; a structured rehabilitation program; lifting restrictions for three months; fusion consolidates over 6–12 months. If the spinal cord was injured, recovery of function depends on the severity of that injury and continues for a year or more with rehabilitation.

At every stage, the goals are the same: protect the nerves, keep the spine aligned while it heals, keep the patient moving, and prevent the next fracture.

Common questions

Do all spinal fractures need surgery?

No. The majority of fractures, including most compression fractures and many burst fractures, heal in a brace. Surgery is for unstable injuries, injuries pressing on the spinal cord or nerves, and fractures with progressive collapse or pain that does not settle.

How long do I have to wear a brace?

Usually 6–12 weeks, depending on the fracture. The brace is a reminder to avoid bending and twisting more than a rigid support; it can be removed for lying down and showering unless you are told otherwise.

Can kyphoplasty be done on an old fracture?

Generally no. Once a fracture has healed, cement adds nothing. MRI shows whether the fracture is still active; that is what determines candidacy, more than the date of the injury.

Not sure this is you?

Bring your imaging and your story. A single visit usually clarifies what is going on and which options are realistic. Request an appointment or call (301) 718-9611.