Burst Fractures of the Second through Fifth Lumbar Vertebrae. Clinical and Radiographic Results*

Andreychik, David; Alander, Dirk H.; Senica, Karolyn; Stauffer, Edouard

doi:10.2106/00004623-199608000-00005

Cited by 74 publications

(55 citation statements)

References 30 publications

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“…When no neurological impairment was seen, conservative treatment including bracing and rest yielded satisfactory results in several series [7,8]. By contrast, compression of neural tissue associated with complete motor impairment is mandatory for laminectomy and/or arthrectomy, the last depending on whether facet dislocation is present [7,19]. Posterior decompression is easily associated with pedicular screw fixation, and transpedicular bone implantation is also possible [3].…”

Section: Discussionmentioning

confidence: 99%

“…forces, which are mostly exerted on the posterior half of the vertebral body [7,8]. The anterior approach may be an option when decompression and/or reconstruction is needed, and somatectomy may be performed in association with a cage body replacement as it is performed at the thoracolumbar junction [21].…”

Section: Discussionmentioning

confidence: 99%

“…Operating table position included extended hips and knees, in order to obtain reduction of kyphosis and achieving a lordotic fixation. Postoperative and follow-up (mean 22 months, range 10-66) evaluation included neurological improvement, pain [7], canal remodeling [17] and L4-S1 angle measurement [1].…”

Section: Methodsmentioning

confidence: 99%

“…Very little has been written [2][3][4][5] and some of the published papers include either L3 and L4 fractures [6][7][8] or patients with no neurological impairment undergoing conservative treatment [9][10][11][12]. Burst or compression fractures type A in Magerl classification [13] are more frequently found, whilst flexiondistraction fractures (type B) and fractures with rotation/ dislocation (type C) are uncommon [14].…”

Section: Introductionmentioning

confidence: 99%

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Neurological L5 burst fracture: posterior decompression and lordotic fixation as treatment of choice

Ramieri

Domenicucci

Cellocco³

et al. 2012

Eur Spine J

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Purpose We report our experience and literature review concerning surgical treatment of neurological burst fractures of the fifth lumbar vertebra. Materials and methods Nineteen patients with L5 neurological burst fractures were consecutively enrolled; 6 patients had complete motor deficits, and 12 had sphincter dysfunction. We performed 18 posterior and one combined approaches. To avoid kyphosis, posterior internal fixation was achieved by positioning patients on the operating table with hips and knees fully extended. At the latest follow-up (mean 22 months, range 10-66), neurological recovery, canal remodeling and L4-S1 angle were evaluated. Results Vertebral body replacement was difficult, which therefore resulted in an oblique position of the cage. Vertebral bodies still remained deformed, even though fixation allowed for an acceptable profile (22°, range 20-35). We observed three cases of paralysis, five complete, and three incomplete recoveries. In the remaining eight patients, sphincter impairment was the only finding. In 15 patients, pain was absent or occasional; in four individuals, it was continuous but not invalidating.Remodeling was visible by X-ray and/or CT, without significant secondary stenosis. Conclusions The L5 burst fractures are rare and mostly due to axial compression. Cauda and/or nerve root injuries are absolute indications for surgery. If an anterior approach is technically difficult, laminectomy can allow for decompression, and it can be easily combined with transpedicular screw fixation. Posterior instrumented fusion, also performed with the aim to restore sagittal profile, when associated with an accurate spinal canal exploration and decompression, may be looked at as an optimal treatment for neurological L5 burst fractures.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Neurological L5 burst fracture: posterior decompression and lordotic fixation as treatment of choice

Ramieri

Domenicucci

Cellocco³

et al. 2012

Eur Spine J

View full text Add to dashboard Cite

show abstract

“…This may partly explain the variations in the results of conservative treatment and the differences in failure rates of posterior fixation reported in the literature [3-7, 15-17, 22-25]. Disc space narrowing has commonly been observed and has been has been associated with recurrent kyphosis and as well as complications after posterior fixation [1,2,4,8,21,22]. A biomechanical study showed that about 60% of the acute hypermobility after a compression-type fracture is situated in the surrounding discs [13].…”

Section: Introductionmentioning

confidence: 99%