News of NASCAR champion Tony Stewart’s latest injury sent ripples through the racing world this month as fans and friends immediately realized that he definitely would NOT be in the driver’s seat for the Daytona 500 season opener on Feb. 21. In fact, there is currently no set timetable for when Stewart will return to the track after suffering a burst fracture of his L1 vertebra during a rollover dune buggy accident in California.
While reports now say that Stewart should make a “full recovery” after undergoing back surgery in North Carolina, the pro driver appears to have been extremely fortunate to have avoided a potentially disabling injury during what was clearly a very scary accident and its aftermath.
For one thing, members of Stewart’s outing who discovered him about 90 minutes after the accident said that he had gotten out of his all-terrain vehicle and was “walking around,” albeit in serious pain. While the fact that he could move all of his extremities was a very promising sign, patients with a burst vertebra are usually not able to walk and should be kept lying on their back until emergency help arrives and their spine can be immobilized. If Stewart really was walking around after the accident, this could have put him at increased risk of neurologic and/or spinal cord damage.
How serious is a burst L1 vertebra?
The L1 vertebra is the topmost vertebra in the lumbar (lower) spine, and a burst fracture of this or any other vertebral bone is a truly serious injury. This is a type of fracture that occurs when high-energy trauma (typically from a car accident or significant fall) causes the vertebra to be crushed on all sides. Compared to a compression fracture in which just the front portion of the bone is crushed, this type of injury can be much more grievous - both because of the potential for the spinal cord to be impacted by a bone fragment and because of the greater amount of instability to which the spine is subjected.
People who sustain a burst vertebral fracture have a possibility of avoiding serious neurologic injury, as appears to be the case with Stewart, but they can also suffer paralysis or at least partial loss of feeling in parts of the body located below the injury site – including loss of bowel or bladder function. In almost all cases, patients with a burst fracture experience severe pain at the spot where the fracture occurs, which may be accompanied by shooting pains down the legs due to compression of the spinal cord.
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What surgical treatment might Stewart have received, and what is his long-term prognosis?
The type of injury that Stewart suffered typically requires emergency treatment to stabilize the spine and reduce the possibility of further impacts to the spinal cord. Upon reaching the hospital, the driver would have been subjected to a complete physical examination followed by a battery of neurological tests to determine whether he had lost any feeling in his limbs, pelvis, abdomen or elsewhere below where the break occurred. He would also certainly have had multiple imaging studies such as X-rays, CT and MRI scans so doctors could visualize the extent and specifics of his injuries.
The fact that Stewart underwent surgery for his burst fracture indicates that it was an unstable injury where one or more bone fragments were separated and/or possibly causing compression of the spinal cord. Surgical correction of such an injury is aimed at decompressing the spinal canal and stabilizing the location where the fracture occurred. The decompression procedure is a laminectomy, where the bony arch that covers the spinal canal is removed, bone fragments or other material are cleared and the spinal cord is given some extra space.
After this was accomplished, a spinal fusion was likely necessary to add stability to the spine and keep the vertebra in the injured area from rubbing against one another. Depending on the extent and specifics of Stewart’s injury, this fusion may have been accomplished via lumbar dynamic stabilization, a minimally invasive XLIF and DLIF procedure or a lumbar discectomy fusion. It’s also quite possible that stabilizing Stewart’s spine at the point of fracture required surgical instrumentation such as metal screws, rods or cages.
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While the specifics of Stewart’s surgery have not been reported, what’s certain is that the 44 year-old has a long road of rehabilitation and recovery ahead of him – and that his goal of returning to the track for a portion of the current Sprint Cup racing season will be tough to achieve. Going forward, physical therapists will no doubt help the embattled pro driver to manage his pain and restore as much of his mobility as possible – in fact, as recently as Friday he was reportedly up and walking on a treadmill. However, with Stewart already having deemed this his final season before retirement, it remains to be seen whether his road to recovery will indeed put him back behind the wheel of the No. 14 Chevrolet this year.
Tony Stewart to miss start of NASCAR season with back injury (2/4/2016). SBNation.com: http://www.sbnation.com/nascar/2016/2/4/10916640/tony-stewart-back-injury-2016-daytona-500
Tony Stewart out of bed, streams update from treadmill (2/12/2016). Yahoo! Sports: http://sports.yahoo.com/news/tony-stewart-live-streams-injury-treadmill-163425382--nascar.html
Burst Fractures: Defined and Diagnosed (n.d.). SpineUniverse.com: http://www.spineuniverse.com/conditions/spinal-fractures/burst-fractures-defined-diagnosed
Fractures of the Thoracic and Lumbar Spine (n.d.). American Academy of Orthopaedic Surgeons: http://orthoinfo.aaos.org/topic.cfm?topic=a00368