It doesn’t, not always. It’s possible to recover completely and be fine; it’s also possible to become a quadriplegic. It’s also possible that, yes, you die.
It all has to do with the *spinal cord,* the bundle of nerves inside your spine. If *that* breaks, your brain becomes separated from your body and can no longer direct it. If it breaks high enough, you can no longer breathe, and you’ll probably die in that case.
But it’s by no means an assured thing like the movies would have us believe.
Your respiratory control centres are in your brain stem. If the fracture causes damage to the spinal cord, the signals to make you breath can’t make it through. Therefore, you won’t breath.
There is a saying: “C5 to stay alive”. If there is spinal cord damage above level C5 you will most likely die. Below C5 you have a chance as the phrenic nerve can still bring signals down to the diaphragm and allow you to breathe a little even with the other chest wall muscles paralyzed.
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