Brazilian star Neymar was injured today while playing soccer. According to his physician, he has an injury that can be treated without surgery. Many back fractures can be treated with bracing and immobilization. The most common of these are:
- Pars interarticularis (“pars”) fracture – This is a fracture of the connection between two levels in your spine. The spine is actually composed of 24 individual segments of the spine (7 cervical, 12 thoracic, and 5 lumbar) followed by the sacrum and coccyx at the end of the spine. Each of these levels is connected to the next and prior level through joints. The pars is part of that connection between two levels (between the superior and inferior articular process). These fractures can create an unstable spine, but in many cases can be treated with bracing. Sometimes these are found as stress fractures.
- Spinous process fracture – The spinous process is the part of the spine that you can feel as bumps on your back. These are benign and heal with time and typically do not require surgery. Commonly, these are caused by sudden contractions of the muscles in your spine. They can be associated with fractures of the lamina, which need closer examination for surgery and can lead to injury to the nerves.
- Transverse process fracture – The transverse process is the “wing” of the vertebral body. These are also benign and heal with time and do not require surgery.
- Compression fracture – This is the fracture commonly seen in elderly patients with osteoporosis. In these fractures, the body is crunched down, much like stepping on an empty coke can. These can be treated with a kyphoplasty (insertion of cement into the fractured part of the bone) or with bracing depending on the symptoms and desires of the patient. A kyphoplasty is typically very well tolerated and has very good pain relief either immediately or within a few days. This is done as an outpatient. A more severe form of a compression fracture is a burst fracture, and these can require surgery if the fracture is pushing on nerves and causing numbness, tingling, or weakness in the legs or arms due to the fracture.
- Facet fracture – These are the joints of the spine. Facet fractures can be unstable and require surgery. Sometimes the joints can dislocate in association with a fracture and this will require surgery and can lead to injury to the spinal cord or nerves.
