Vertebral fractures, i.e. fractures in the spinal column, can be divided into fractures of the vertebral body, the transverse processes or the spinous processes. A spinous process fracture is a spinal fracture in which the spinal process (processus spinosus) of the vertebral body either breaks off completely or partially. The spinous process is located at the back of the vertebral arch and forms a starting point for many large skeletal muscles and the autochthonous back muscles, which are important for segmental stability.
The spinous processes of our spinal column are the protrusions that we can see through the skin as a bulge along the spinal column. Due to their location, they are particularly prone to break during falls. A spinous process may also break due to muscle tension.
Therapy and treatment
In addition to the localization of the fracture, the division into stable and unstable fractures is important for therapy. In the case of a fracture of the spinous process alone, the stability of the spine is usually not affected. If the vertebral arch is also affected, it is usually not an isolated spinous process fracture.
A different treatment then follows. If a piece of a spinous process has broken off due to a fall, for example, this can often be treated conservatively. This means that the fracture is first immobilized if possible to give the fracture a chance to heal.
Acute pain and signs of inflammation are alleviated by targeted pain medication with mostly non-steroidal anti-rheumatic drugs (NSAIDs). This can be followed by a constructive physiotherapy. If several spinous processes are fractured, an operation is necessary to provide the autochthonous back muscles, which are inserted here, with enough stable attachment surface.
The spinous processes are then surgically reattached and the result of the operation is immobilized for some time until it has healed safely and firmly. This is usually accompanied by a drug therapy with NSAIDs. Intensive physiotherapy is important in order to train the muscles again and thus ensure stability in the spine as soon as the fracture has healed sufficiently and is stable for exercise.
Posture training is important, as is targeted strength training of the autochthonous and large back muscles. Coordination should also be improved in order to avoid later back pain due to lack of stability and incorrect loading. The use of tape bandages or corsets as well as electrotherapy and heat treatments can complement the therapy.
Soft tissue treatments such as friction or massages can also be useful to detonate the tense muscles in the fracture area and relieve pain. Especially at the beginning of the therapy it is important to learn back-friendly behaviour in everyday life. Standing up and sitting down, turning to the side or similar everyday transfers can be practiced so that no unfavorable shear forces act on the fracture. Lying supine should be avoided in the case of a spinous process fracture. You can also find other back-protecting behaviors under Back school.
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