Low Lumbar Spine Fracture

Abstract

Background and Objective: The aim of this retrospective study was to evaluate the outcome of short-segment dorsal stabilization and fusion with transpedicular bone grafting with regard to the success of correction and the functional results in fractures of the lower lumbar spine. Patients and Methods: Out of 39 patients with a fracture of the third to fifth lumbar vertebra treated operatively, 31 were followed up clinically and radiologically over an average period of 26 months (12–61 months). Parameters describing changes at the fracture level and in the adjacent intervertebral spaces were measured by means of imaging investigations. The functional results of treatment were also recorded and compared to the radiologic data. Results: The correction observed radiologically showed a different pattern depending on the fracture level. In fractures of the third and fourth lumbar vertebrae, there was marked vertebral wedging on the one hand, while, on the other hand, there was a considerable loss of correction postoperatively, particularly in the cranial intervertebral space. Finally, the kyphotic angle at the time of follow-up did not differ significantly from the preoperative levels. On the other hand, marked vertebral wedging was not observed in fractures of the fifth lumbar vertebra. In these fractures, the radiologic parameters therefore did not demonstrate significant changes throughout the course. Four patients (12.9%) had an incomplete neurologic deficit preoperatively. An improvement of at least one Frankel stage was observed subsequently in three of these patients. However, postoperative neurologic complications were found in two patients (6.4 %) in whom the initial neurologic examination was unremarkable. The radiologic parameters did not correlate with the functional results. The functional result was classified as satisfactory in 29 patients (93.5%), yet as unsatisfactory in two (6.4%). Conclusions: Stable restoration of regional lordosis could be not achieved with the operative procedure that was employed. This procedure is also characterized by a high rate of complications and cannot be recommended in future. In particular, conservative treatment methods appear to be a sensible alternative.