L4 fractures, biomechanics of cure foretold

Abstract

Objectives: To analyze the clinical and radiographic outcomes in fracture of the fourth lumbar vertebra, under conservative or surgical treatment. Methods: Patients diagnosed with L4 fracture with or without neurological injury were studied and to whom conservative or surgical treatment was provided. Radiographic measurements were performed taking into account the kyphosis angle, the sagittal index, loss of vertebral body height, percentage of canal occlusion and height compression percentage. Results: Twenty-five patients were treated, five conservatively and 20 surgically. The vertebral kyphosis angle in both groups was 12°, no regional kyphosis was present, the sagittal index was 11.9 (Farcy), the loss of vertebral body height was 53.17%, the percentage of canal occlusion was 23% and the height compression percentage was 38.06%. The residual pain according to the visual analog scale was two in both groups. Conclusions: Patients with a fractured L4 have a satisfactory outcome with both treatments, the height of the vertebral body remains the same, the lordosis is preserved and therefore the sagittal balance, allowing recovering the mechanical functions of the spine as opposed to other segment fractures.

One-stage posterior only corpectomy and fusion in the treatment of a unique acute low lumbar L4 burst fracture without neurologic deficit: A case presentation

“…Its regular lordosis permits the midpoint of gravity to drop posterior to the center of the body of L4 vertebra [ Figure 4 ], cause fractures of lower lumbar fewer vulnerable to collapse or kyphosis, event that is routine in the thoracolumbar junction. [ 3 10 ]…”

“…Treatments need to be customized, and the recommendations for thoracolumbar trauma managing cannot essentially be shifted to low lumbar trauma. [ 3 ]…”

Low Lumbar Fractures: Unique Biomechanics and Treatment Options

“…Regular lordosis of the lower lumbar L4 spine permits the midpoint of gravity to drop posterior center of the body of L4 vertebra (Figure 1), causing fractures of lower lumbar less vulnerable to collapse or kyphosis which is routine in the thoracolumbar junction [3,12]. Neurologic problems can be restricted via a wide neural canal, making the cauda equine less prone to damage, and increase the rate of recovery [13].…”

“…Lastly, the position of L5 on the edge of the upper part of the pelvic and ligaments between lumbar and sacroiliac regions makes a fixed situation for the uncommon lesions of this vertebra [3,14,15] (Figure 2). The practical importance of the flexibility of the lumbar spine leads us to control the degree of the fixation and stabilization of the moveable parts through the treatment [4,[15][16][17].…”

“…The ideal treatment of thoracolumbar and lumbar fractures has remained controversial. The exclusive features of the lower spine and insufficient literature on the fractures in this area are still a challenge for making helpful decisions [3].…”