What it is
Not all spinal fractures require surgery. Stable compression fractures from osteoporosis — where the vertebra has collapsed but the spinal column remains aligned and the cord is not at risk — are typically managed conservatively with bracing and pain management, or with minimally invasive cement augmentation (kyphoplasty). Surgical stabilization is reserved for fractures that are mechanically unstable, neurologically compromising, or failing non-operative management.
Fracture stabilization most commonly involves placing pedicle screws into the vertebrae above and below the fracture, connected by rods, to restore and maintain alignment while the fracture heals. For burst fractures with significant anterior column disruption, anterior reconstruction — replacing the damaged vertebral body with a cage — may be added to fully restore stability.
Types of spinal fractures requiring stabilization
Burst fractures: High-energy fractures where the vertebral body shatters and bone fragments may retropulse into the spinal canal. Instability depends on the degree of canal compromise, posterior ligamentous disruption, and the patient's neurological status.
Fracture-dislocations: High-energy injuries with disruption of both anterior and posterior columns and translational deformity. These are almost always unstable and require surgical fixation.
Pathologic fractures: Fractures through bone weakened by tumor metastasis or primary bone lesions. Stabilization — often combined with decompression and radiation planning — allows the patient to remain ambulatory and is an important component of oncologic spine care.
Timing
For fractures with acute neurological deficit, surgical decompression and stabilization is performed urgently. For neurologically intact patients with unstable fractures, surgery is typically performed within 24–48 hours after appropriate workup. Early surgical stabilization allows earlier mobilization and reduces complications associated with prolonged bed rest.