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.
Highlights
IntroductionFractures of the lower spine constitute 14% of all thoracolumbar lesions,[1] and are the result of high-impact traumas.[2]
Fractures of the lower spine constitute 14% of all thoracolumbar lesions,[1] and are the result of high-impact traumas.[2]There are unique anatomical characteristics and specific biomechanics in the lumbar segment (L4-L5) that influence the response to trauma, and can justify different treatment approaches in this type of fracture.[3]Its natural lordosis allows the center of gravity to fall posterior to the center of the vertebral body of L4 (Figure 1), making lower lumbar fractures less susceptible to collapse and kyphosis, which is common in fractures of the thoracolumbar joint (T11-T12).[4]
Data were gathered in relation to age, sex, type of fracture according to the new AO Spine classification of injuries of the thoracic and lumbar spine, ASIA (American Spine Injury Association), as well as residual pain at the end of follow-up, according to the visual analog scale (VAS)
Summary
Fractures of the lower spine constitute 14% of all thoracolumbar lesions,[1] and are the result of high-impact traumas.[2]. Its natural lordosis allows the center of gravity to fall posterior to the center of the vertebral body of L4 (Figure 1), making lower lumbar fractures less susceptible to collapse and kyphosis, which is common in fractures of the thoracolumbar joint (T11-T12).[4] Neurological complications are limited by an ample neural canal, making the cauda equina less susceptible to injury, and giving a higher potential for its recovery.[5] the location of L5 below the edge of the superior portion of the pelvis and its lumbar-sacroiliac ligaments creates a stable environment for the infrequent lesions of this vertebra.[6] (Figure 2) The functional importance of the mobility of the lumbar spine leads us to limit the extent of the fixation and preserve the mobile segments during the treatment..
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