Low Lumbar Burst Fractures Research Articles

Low Lumbar Fractures: Unique Biomechanics and Treatment Options

Background and Aim: Acute lower lumbar spinal fractures (L4 and L5) can cause major neurologic damage and mechanical instability. The ultimate surgical method for the management of unstable lower lumbar spine fractures Methods and Materials/Patients: Online search databases including Google scholar databases, PubMed and Ovid was performed using the keywords: Low lumbar, fractures, spine trauma, biomechanics, classification, anatomy, spinopelvic alignment, non-operative and surgical treatment options. Finally, about 47 related studies were identified and reviewed. Results: The L4 and L5 vertebra and related discs contribute to 50% of the lordosis in the lumbar area. Fracture of the trapezoidal body of the fifth vertebra can considerably decrease this and change the L4-L5 and L5-S1 biomechanics. The lower lumbar spine, in contrast to the thoracolumbar junction, is secure by the pelvis and the robust musculature. There is great controversy about the treatment of lumbar burst fractures without neurologic deficit. The surgical indication and optimal procedure may be influenced by numerous aspects such as the severity of signs and symptoms, the amount of loss of vertebral body height and the involvement of the spinal canal, and finally, the stability of the posterior spinal components. Conclusion: There is no consensus on what establishes the paramount treatment for low lumbar burst fractures. Conservative care has been related to acceptable outcomes for patients with a burst fracture which are neurologically intact. In more severe injuries, spinal decompression and stabilization via a posterior or anterior approach are based on the surgeon’s preference. For lower lumbar burst fractures or fracture-dislocations of the lumbosacral junction with neurologic injury, posterior decompression and stabilization, and a period of rest and bracing for the preservation of lumbar lordosis are appropriate.

Functional outcome of management of lower lumbar (L-3 to L-5) burst fractures: A multicentre study of 34 cases

Aim and Objective: Lower lumbar burst fractures are rare entity with most of the literature restricted to small case series. There is no clear cut consensus on the guidelines for management. Here we present functional results of different modalities of treatment of this rare type of spine injury.Material and Methods: The study was conducted at two tertiary care centres over a period of 9 years. Patients with lower lumbar burst fractures were evaluated for associated injuries, modality of treatment, Pain score (VAS) and neurological status (Frankel Grade) at the time of injury and at final follow up were recorded. The final functional outcome was evaluated using Smiley-Webster functional score.Results: A total of 34 patients with an average age of 37.3 years (24 males; 10 females) and a mean final follow up of 27.9 months were enrolled. 21 patients had L3, 8 had L4 and 5 had L5 burst fractures. 10 patients were managed conservatively by brace and 24 underwent surgical intervention. The pain score (VAS) improved from a mean of 8.5 at the time of injury to a mean of 1.6 at final follow up. Patients with neurological injury had on average improvement of one Frankel grade. 88% patients had excellent to good final functional outcome.Conclusion: Lower lumbar burst fractures are high velocity injuries with other non-spinal injuries being associated. Most of the patients have good functional outcome with both conservative as well as surgical intervention. Patients with complete cauda equina have poor outcome with respect to neurological recovery.

Single-stage Transpedicular Vertebrectomy and Expandable Cage Placement for Treatment of Unstable Mid and Lower Lumbar Burst Fractures.

Retrospective clinical and radiographic study. To examine the efficacy and safety of vertebrectomy and expandable cage placement by a single-stage posterior approach for unstable mid and lower lumbar burst fractures (below the L3). Patients with unstable mid and lower lumbar burst fractures require surgical treatment to relieve pain, address paralysis, and stabilize the spine to prevent further segmental deformity. However, controversy remains regarding the optimal surgical treatment. Eleven patients underwent single-stage posterior-only vertebral column resection and vertebral body reconstruction using an expandable cage. Neurological status was classified using the American Spinal Injury Association (ASIA) Impairment Scale, whereas functional outcome was analyzed using a visual analog scale for back pain. Segmental Cobb angles were measured above and below the fractured vertebral body preoperatively, immediate postoperatively, and at the last follow-up. The preoperative neurological status was ASIA grade E in 2 patients, grade D in 5 patients, grade C in 2 patients, and grade B in 2 patients. Postoperatively, neurological stability was demonstrated in 3 patients (27%), and 8 (73%) showed improvement in the ASIA grade. The mean preoperative visual analog scale score was 8.3, which decreased to 4.5 postoperatively, and to 1.8 at the final follow-up. The mean preoperative segmental lordotic angle was 9.2 degrees, which increased to 16.9 degrees postoperatively, and decreased to 15.1 degrees at the last follow-up. The mean operating time was 208.8 minutes, and the mean blood loss was 1006.3 mL. Regarding surgical complications, 1 patient experienced a dural tear and 1 patient demonstrated cage subsidence. The results of this small series suggest the feasibility, efficacy, and safety of this surgical option for unstable mid and lower lumbar burst fractures. This technique from a single posterior approach offers several advantages over traditional anterior or combined approaches using strut graft or nonexpandable implants.

Outcomes After Operative Management of Combat-Related Low Lumbar Burst Fractures.

Retrospective review. Report the 2-year operative and clinical outcomes of these service members with low lumbar fractures. The majority of spinal fractures occur at the thoracolumbar level, with fractures caudal to L2 accounting for only 1% of spine fractures. A previous report from this institution regarding combat-related spine burst fractures documented an increased incidence of low lumbar burst fractures in injured service members. Review of inpatient and outpatient medical records in addition to radiographs for all patients treated at our institution with combat-related burst fractures occurring at the L3-L5 levels. Twenty-four patients with a mean age of 28.1± 7.2 underwent surgery for low lumbar (L3-L5) burst fractures. The mean number of thoracolumbar levels injured was 2.9 ± 1.4. Eleven patients had neurological injury, 4 of which were complete. The mean days to surgery were 16.8 ± 24.5. The mean number of levels fused was 4.3 ± 2.1, with fixation extending to the pelvis in 4 patients (17%). Fourteen (61%) patients had at least 1 postoperative complication, with 7 (30%) requiring reoperation. Five patients had a postoperative wound infection. Five patients had deep venous thromboses, 3 had pulmonary emboli. Mean clinical follow-up was 3.3± 2.2 years. At latest follow-up, all were separated from military service, 10 experienced persistent bowel/bladder dysfunction, 15 had lower extremity motor deficits, and 10 had documented persistent low back pain. Nineteen had chronic pain with 18 patients still taking pain medications and/or muscle relaxers. Low lumbar burst fractures are a rare injury with an increased incidence in combat casualties engaged in the wars in Iraq and Afghanistan. We found a high rate of acute postoperative complications (61%), as well as a high reoperation rate (30%). At approximately 3 years of follow-up, most of these patients had persistent neurological symptoms and chronic pain. 4.

Pedicle screw fixation for low lumbar burst fracture with grade 4 retrolisthesis without any neurological deficit

Abstract Burst fractures of the spine account for 14% of all spinal injuries. Lower lumbar burst fracture with retrolisthesis is a rare presentation of traumatic cause. Management of this type of fracture are controversial and depends on plenty of factors like age of patient, type of injury, neurological deficit, associated comorbit injury. Here we are discussing a rarest case of traumatic burst fracture of L4 vertebrae with grade 4 retrolysthesis of L4 on L5 vertebrae with severe secondary canal stenosis and neurologically intact, which was manage with pedicle screw fixation.

The analysis of functional and radiographic outcomes of conservative treatment in patients with low lumbar burst fractures

IntroductionBurst fractures of the low lumbar spine constitute approximately one percent of all lumbar fractures. There is still no consensus on the optimal treatment of low lumbar burst factures. We aimed to evaluate the functional and radiographic outcomes of conservative treatment in patients with low lumbar burst fracture. Methods15 patients (11 males, 4 females; mean age 32±8) who had low lumbar spine burst fracture treated with a custom-moulded thoracolumbosacral orthosis (TLSO) with a thigh extension were enrolled. The mean follow-up period was 22±6 months. 14 patients were neurologically intact and one had isolated nerve root injury. There were 24% type A fractures and 76% type B fractures according to the Denis classification system. Functional outcomes were evaluated by using Oswestry Disability Index (ODI), Short-Form 36 (SF-36) and Visual Analogue Scale (VAS). Radiographic outcome was analyzed by measuring anterior vertebral height loss, kyphosis angle, amount of canal retropulsion. Functional and radiographic outcomes were reviewed initially and at 1, 3, 6, 12 months, and at the latest follow-up. Functional and radiographic improvements were analyzed statistically. ResultsThe mean bracing period was 11.9±1.7 weeks. The mean initial ODI, SF-36, and VAS score of the patients was 78.3±9.6, 23.7±8.9, and 8.7±0.7, respectively. The mean ODI, SF-36, and VAS score of the patients at the final follow-up was 26.4±6.5, 68.1±11.2, and 2.8±1.7, respectively. The improvement in functional outcomes was measured to be significant (p<0.05 for ODI, SF-36 and VAS). The mean initial anterior vertebral height loss, kyphosis angle, amount of canal retropulsion was found to be 27.2%±9.6%, −6.8°±3.2°, 37.4%±10.2%, respectively. The mean anterior vertebral height loss, kyphosis angle, and amount of canal retropulsion at the final follow-up was 23.1%±.6.7%, −4.2°±2.4°, 19.6%±7.7%, respectively. Among the radiographic outcomes, only the amount of canal retropulsion improved statistically (p=0.042). ConclusionConservative treatment using a custom-moulded thoracolumbosacral orthosis with a thigh extension is a safe and effective method in patients with low lumbar spine burst fractures and can improve functional and radiographic outcomes.

Single-Stage Posterior Vertebral Body Resection and Reconstruction Using Expandable Cage for Unstable Mid and Lower Lumbar Burst Fractures

Introduction Patients with unstable mid and lower lumbar burst fractures require surgical treatment to relieve pain, address paralysis, and stabilize the spine to prevent further segmental deformity. However, controversy remains regarding the optimal surgical treatment. The purpose of this study is to examine the efficacy and safety of corpectomy and expandable cage placement via a single-stage posterior approach for unstable mid and lower lumbar burst fractures (below the L3). Patients and Methods A total of 11 patients underwent single-stage posterior-only vertebral column resection and vertebral body reconstruction using an expandable cage. Neurologic status was classified using the American Spinal Injury Association (ASIA) Impairment Scale, while functional outcome was analyzed using a visual analog scale (VAS) for back pain. Segmental Cobb angles were measured above and below the fractured vertebral body preoperatively, immediate postoperatively, and at the last follow-up. Results The preoperative neurologic status was ASIA grade E in two patients, grade D in five patients, grade C in two patients, and grade B in two patients. Postoperatively, neurologic stability was demonstrated in three patients (27%), and eight patients (73%) showed improvement in the ASIA grade. The mean preoperative VAS score was 8.3, which decreased to 4.5 postoperatively, and to 1.8 at the final follow-up. The mean preoperative segmental lordotic angle was 9.2 degrees, which increased to 16.9 degrees postoperatively, and decreased to 15.1 degrees at the last follow-up. The mean operating time was 208.8 minutes, and the mean blood loss was 588 mL. Regarding surgical complications, one patient experienced a dural tear and one patient demonstrated cage subsidence. Conclusion The results of this small series suggest the feasibility, efficacy, and safety of this surgical option for unstable mid and lower lumbar burst fractures. This technique from a single posterior approach offers several advantages over traditional anterior or combined approaches using strut graft or nonexpandable implants.

A Transdural Approach for Lower Lumbar Burst Fractures. A Novel(Kotil) Technical Note

The treatment of surgical procedure of lower lumbar burst fractures is challenged. The optimal method remains controversial. To assess the usefulness and safety of a novel both decompression and reconstructive procedures known as transdural approaches of lower lumbar spine burst fracture. For this reason, we presented the results of a trans-dural approach which is a new technique. We presented the reconstruction and dural repairing results of 5 cases that were operated on between the years 1995-2011 due to lower lumbar burst fractures with a trans-dural surgical technique. Cases were chosen for this technique according to the presence of lamina fractures displayed on tomography (CT) and lumbar (MRI). Intra canal fragments, lamina fractures were determined. The postoperative opening of the spinal canal, the loss of height of the middle and anterior column and the postoperative fusion results were investigated. The surgical results of the cases were classified according to the Odom’s criteria. No instances of neurological deterioration and instrument failure occurred and no complications were noted with the use of this technique. All five patients had neurological function recovery at the most recent follow-up visit. In conclusion, this reported new surgical approach is an efficient and safe method for the treatment of traumatic lower lumbar burst fractures.

Short Segment Screw Fixation without Fusion for Low Lumbar Burst Fracture: Severe Canal Compromise but Neurologically Intact Cases

Burst fractures of the low lumbar spine (L3-5) represent a small percentage of all spinal fractures. Due to their rarity, most of the literature regarding the best treatment for burst fractures concerns the thoracolumbar junction, rather than the low lumbar region. Fractures of these vertebrae have biomechanical and anatomic characteristics that distinguish them from thoracolumbar burst fractures. In particular, the iliolumbar ligaments and a location below the pelvic brim with major muscle support are two stabilizing factors that are unique to these fractures. Furthermore the spinal canal is widest in the low lumbar region. As a results, neurologic deficits are rare in low lumbar burst fracture compared with thoracolumbar burst fracture. The relative and absolute indications for surgery or conservative treatment for the management of low lumbar burst fractures remain controversial, especially in neurologically intact patients with severe canal compromise. Conservative treatment, including prolonged bed rest with subsequent bracing, has proven to be an effective means of treating low lumbar burst fractures. On the other hand, surgical treatment provides immediate spinal stability and more reliably restores sagittal alignment and canal dimensions. However, despite the advantages of earlier ambulation and anatomic reduction, due to major muscle support and forceful retraction for lateral to medial direction to insert screws, long segment fusion should be avoided in patients with a low lumShort Segment Screw Fixation without Fusion for Low Lumbar Burst Fracture: Severe Canal Compromise but Neurologically Intact Cases

Low lumbar burst fractures: a unique fracture mechanism sustained in our current overseas conflicts

The most common location for burst fractures occurs at the thoracolumbar junction, where the stiff thoracic spine meets the more flexible lumbar spine. With our current military conflicts in Iraq and Afghanistan, we have seen a disproportionate number of low lumbar burst fractures. To report our institutional experience in the management of low lumbar burst fractures. Retrospective review. We performed a retrospective review of medical records and radiographs for all patients treated at our institution with combat-related injuries and thoracolumbar fractures. We included all patients who had sustained a burst fracture from T12 to L5 and had at least 1-year clinical follow-up. Thirty-two patients sustained burst fractures. Nineteen patients (59.4%) had low lumbar (L3-L5) burst fractures, and 12 patients (37.5%) had thoracolumbar junction (T12-L2) burst fractures as their primary injury. Additionally, seven patients sustained less severe burst fractures at an additional level. One patient sustained burst fractures at both upper and lower lumbar levels. Of the low lumbar fractures, 52.6% had evidence of neurologic injury, two of which were complete. Similarly, in the upper lumbar group, 58.2% sustained a neurologic injury, two of which were complete. Twenty-two patients underwent surgical intervention, complicated by infection in 18%. At most recent follow-up, all but one patient with presenting neurologic injury had persistent deficits. Low lumbar burst fractures are the predominant combat-related spine injury in our current military conflicts. The rigidity offered by current body armor may effectively lower the transition zone that normally occurs at the thoracolumbar junction, thereby, transferring forces into the lower lumbar spine. Increased awareness of this fracture pattern is warranted by all surgeons because of unique clinical challenges associated with its treatment. Although the incidence is increased in the military population, other surgeons may be involved with long-term care of these patients on completion of their military service.

Fusion for Lower Lumbar (L3-L5) Fractures: Surgical Indications and Techniques

Many surgeons acknowledge that anatomical and biomechanical characteristics specific to the lower lumbar (L3-L5) spine influence management after injury. In this review, the literature was evaluated to determine the surgical indications and optimal operative approach for lower lumbar burst fractures, fracture-dislocations, and flexion-distraction injuries. Low-quality studies (eg, retrospective case series, etc) suggest nonoperative and operative management of neurologically intact lower lumbar burst fractures achieve comparable functional results, with greater complication rates noted in surgical cohorts. Although surgical stabilization of injuries with neurological deficits is determined by sound pathophysiological rationale and allows earlier rehabilitation, it remains unclear whether this alters the natural history of neurological recovery. The surgical strategy should aim to preserve motion segments by minimizing fusion levels and, in select cases, stabilization without fusion is supported.

Evaluation and management of combat-related spinal injuries: a review based on recent experiences

The current approach to the evaluation and treatment of military casualties in the Global War on Terror is informed by medical experience from prior conflicts and combat encounters from the last 10 years. In an effort to standardize the care provided to military casualties in the ongoing conflicts, the Department of Defense (DoD) has published Clinical Practice Guidelines (CPGs) that deal specifically with the combat casualty sustaining a spinal injury. However, the combat experience with spine injuries in the present conflicts remains incompletely described. To describe the CPGs for the care of the combat casualty with suspected spine injuries and discuss them in light of the published military experience with combat-related spinal trauma. Literature review. A literature review was conducted regarding published works that discussed the incidence, epidemiology, and management of combat-related spinal trauma. The CPGs, established by the DoD, are discussed in light of actual military experiences with spine trauma, the present situation in the forward surgical teams and combat support hospitals treating casualties in theater, and recent publications in the field of spine surgery. In the conventional wars fought by the United States between 1950 and 1991 (Korea, Vietnam, Gulf War I), the incidence of spine injuries remained close to 1% of all combat casualties. However, in the Global War on Terror, the enemy has relied on implements of asymmetric warfare, including sniper attacks, ambush, roadside bombs, and improvised explosive devices. The increase in explosive mechanisms of injury has elevated the number of soldiers exposed to blunt force trauma and, consequently, recent publications reported the highest incidence of combat-related spinal injuries in American military history. Wounded soldiers are expeditiously evacuated through the echelons of care but typically do not receive surgical management in theater. The current CPGs for the care of soldiers with combat-related spinal injuries should be re-examined in light of data regarding the increasing number of spine injuries, new injury patterns, such as lumbosacral dissociation and low lumbar burst fractures, and recent reports within the field of spine surgery as a whole. American and coalition forces are sustaining the highest spine combat casualty rates in recorded history and previously unseen injuries are being encountered with increased frequency. While the CPGs provide useful direction in terms of the evaluation and management of combat casualties with spine injuries, such recommendations may warrant periodic re-evaluation in light of recent combat experiences and evolving scientific evidence within the spine literature.

Lower lumbar burst fractures treated by trans-pedicle screw system

目的 探讨经伤椎置钉椎弓根螺钉系统内固定治疗下腰椎爆裂性骨折的临床疗效.方法 2001年11月至2009年8月对26例下腰椎爆裂性骨折患者行椎弓根螺钉系统内固定,男19例,女7例;年龄21～56岁,平均37.6岁.所有患者均于伤椎及其上、下相邻椎置入椎弓根螺钉并行后外侧植骨融合.比较术前、术后及未次随访时伤椎椎体的前缘高度比值、腰椎前凸角.结果 本组26例患者术后获12～48个月(平均26.3个月)随访,伤椎椎体前缘高度比值由术前47.35%±6.42%恢复至术后95.35%±6.67%,差异有统计学意义(P＜0.05),末次随访时为94.91%±6.73%,与术后比较差异无统计学意义(P＞0.05).腰椎前凸角由术前30.16°±7.12°恢复至术后39.32°±8.65°,差异有统计学意义(P＜0.05),末次随访时为39.18°±9.72°,与术后比较差异无统计学意义(P＞0.05).随访期间末发生内固定松动、断裂等并发症.末次随访时下腰痛视觉模拟(VAS)评分由术前平均(8.9±1.6)分降至(1.2±0.3)分.术前合并神经损伤的12例患者除2例D级患者无改变外,其余患者美国脊髓损伤学会(ASIA)分级均提高1～2级.结论 经伤椎置钉椎弓根螺钉系统内固定治疗下腰椎爆裂性骨折能有效地维持伤椎复位后的高度及腰椎前凸角,手术创伤小、操作相对简单,是一种治疗下腰椎爆裂性骨折的有效方法。

Surgical treatment of lower lumbar fracture with mini-incision via retroperitoneal anterior approach

Objective To investigate the clinical effects of surgical treatment of lower lumbar fracture with mini-incision via retroperitoneal anterior approach. Methods The data of 21 cases with serious lower lumbar burst fracture were analyzed retrospectively. There were 15 males and 6 females with an average age of 35.9 years （ranged, 19-65 years）. The lesion was located in L3 in 10 cases, L4 in 8 and L5 in 3cases. According to Magerl classification, there was type A （burst in 12 cases, type B （distraction） in 2 and type C （retortion） in 7 cases. All the 21 cases were treated with anterior decompression, bone graft fusion and internal fixation with mini-incision via retroperitoneal anterior approach. The changes of radiograph and neurologic status were recorded respectively. Results All the cases had been followed up for an average of 41.9 months （12-86 months）. The radiograph showed obvious improvement on the injured body height （from 42.62% preoperatively to 94.33% postoperatively, P〈0.01） and the canal encroachment index （from 2.67 preoperatively to 0.14 postoperatively, P〈0.01）. Significant improvement in neurological function were achieved in all patients with the improvement of one grade except for 1 case with L3, T11 fracture and complete paraplegia. No failure of implants was found during the follow-up period. Conclusion Anterior decompression and internal fixation with mini-incision via retroperitoneal anterior approach are successful in treating serious lower lumbar burst fractures. Key words: Spinal fractures; Surgical procedures,minimally invasive; Fracture fixation

Relationship between Lamina Fractures and Dural Tear in Low Lumbar Burst Fractures

Relationship between Lamina Fractures and Dural Tear in Low Lumbar Burst Fractures

Screw Fixation without Fusion for Low Lumbar Burst Fracture : A Severe Canal Compromise But Neurologically Intact Case

The low lumbar spine is deeply located in flexible segments, and has a physiologic lordosis. Therefore, burst fractures of the low lumbar spine are uncommon injuries. The treatment for such injuries may either be conservative or surgical management according to canal compromise and the neurological status. However, there are no general guidelines or consensus for the treatment of low lumbar burst fractures especially in neurologically intact cases with severe canal compromise. We report a patient with a burst fracture of the fourth lumbar vertebra, who was treated surgically but without fusion because of the neurologically intact status in spite of severe canal compromise of more than 85%. It was possible to preserve motion segments by removal of screws at one year later. We also discuss why bone fusion was not necessary with review of the relevant literature.

Diagnosis and Management of Low Lumbar Burst Fractures

Fractures of the low lumbar spine are relatively uncommon and have various injury patterns. Treatment must be individualized and should take into account the fracture type, ligamentous injury pattern, neurological injury, the limitations of surgical implants, and the anatomical approaches available. Nonoperative management of burst fractures for patients without neurological deficits has generally been reported to have acceptable outcomes. For low lumbar burst fractures or fracture dislocations of the lumbosacral segment where neurological injury has occurred, surgery is indicated. This surgery should include decompression (posterior or anterior), spinal realignment with maintenance of lumbar lordosis, and instrumentation over minimal segments. Conservatively managed patients require continued follow-up to manage symptoms and check for possible development of deformity.

P73. Low Lumbar Burst Fractures: A Unique Fracture Mechanism Sustained in our Current Overseas Conflicts

BACKGROUND CONTEXT: The most common location for burst fractures occurs at the thoracolumbar junction, where the stiff thoracic spine meets the more flexible lumbar spine. With our current military conflicts in Iraq and Afghanistan, we have seen a disproportionate number of low lumbar burst fractures (caudal to L2).

Low thoracic and lumbar burst fractures: radiographic and functional outcomes

Twenty patients with thoracolumbar burst fractures (type A3 in the classification of Magerl et al.) were studied prospectively for the evaluation of clinical, radiographic and functional results. The patients were submitted to surgical treatment by posterior arthrodesis, posterior fixation and autologous transpedicular graft. The patients were followed up for 2 years after surgery and assessed on the basis of clinical (pain, neurologic deficit, postoperative infection), radiographic (load sharing classification, Farcy s sagittal index of the fractured segment, relation between traumatic vertebral body height and the adjacent vertebrae (compression percentage), height of the intervertebral disk proximal and distal to the fractured vertebra, rupture or loosening of the implants) and functional (return to work, SF-36) criteria. Two patients presented a marked loss of correction and required the placement of an anterior support graft. Pain assessment revealed that eight patients (44%) had no pain; four (22%) had occasional pain, three (17%) moderate pain, and three (17%) severe pain. According to the classification of Frankel et al., 17 patients persisted as Frankel E and one patient presented improvement of one degree, becoming Frankel D. The mean value of Farcy s sagittal index of the injured vertebral segment was 20.67 degrees +/- 6.15 degrees (range 8 degrees -32 degrees ) during the preoperative period, 11.22 degrees +/- 8.09 degrees (range -5 degrees to 21 degrees ) during the immediate postoperative period, and 14.22 degrees +/- 7.37 degrees (range 3 degrees -25 degrees ) at late evaluation. There was a statistically significant difference between the immediate postoperative values and the preoperative and late postoperative values. The compression percentage of the fractured vertebral body ranged from 9.1 to 60 (mean 28.81 +/- 11.51) during the preoperative period, from 0 to 60 (mean: 15.59 +/- 14.49) during the immediate postoperative period, and from 8 to 60 (mean: 25.9 +/- 13.02) at late evaluation. There was a statistically significant difference between the preoperative and postoperative values and between the postoperative and late postoperative values. The height of the proximal intervertebral disk ranged from 6 to 14 mm (mean 8.44 +/- 2.66) during the preoperative period, from 6 to 15 mm (mean 10 +/- 2.30) during the immediate postoperative period, and from 0 to 11 mm (mean 7.22 +/- 2.55) during the late postoperative period. A significant difference was observed between the immediate postoperative values and the preoperative and late postoperative values. The height of the intervertebral disk distal to the fractured vertebra ranged from 7 to 16 mm (mean 9.94 +/- 2.64) during the preoperative period, from 5 to 18 mm (mean 11.61 +/- 3.29) during the immediate postoperative period, and from 2 to 14 mm (mean 9.72 +/- 3.17) during the late postoperative period. There was a significant difference between the immediate postoperative values and the preoperative and late postoperative values. Except for the height of the intervertebral disk proximal to the fractured vertebra, no correlation was detected between the clinical, functional and radiologic results. The results observed in the present study indicate that other, still incompletely defined parameters influence the functional result of thoracolumbar burst fractures.

Decision-making in burst fractures of the thoracolumbar and lumbar spine

The most common site of injury to the spine is the thoracolumbar junction which is the mechanical transition junction between the rigid thoracic and the more flexible lumbar spine. The lumbar spine is another site which is more prone to injury. Absence of stabilizing articulations with the ribs, lordotic posture and more sagitally oriented facet joints are the most obvious explanations. Burst fractures of the spine account for 14% of all spinal injuries. Though common, thoracolumbar and lumbar burst fractures present a number of important treatment challenges. There has been substantial controversy related to the indications for nonoperative or operative management of these fractures. Disagreement also exists regarding the choice of the surgical approach. A large number of thoracolumbar and lumbar fractures can be treated conservatively while some fractures require surgery. Selecting an appropriate surgical option requires an in-depth understanding of the different methods of decompression, stabilization and/or fusion. Anterior surgery has the advantage of the greatest degree of canal decompression and offers the benefit of limiting the number of motion segments fused. These advantages come at the added cost of increased time for the surgery and the related morbidity of the surgical approach. Posterior surgery enjoys the advantage of being more familiar to the operating surgeons and can be an effective approach. However, the limitations of this approach include inadequate decompression, recurrence of the deformity and implant failure. Though many of the principles are the same, the treatment of low lumbar burst fractures requires some additional consideration due to the difficulty of approaching this region anteriorly. Avoiding complications of these surgeries are another important aspect and can be achieved by following an algorithmic approach to patient assessment, proper radiological examination and precision in decision-making regarding management. A detailed understanding of the mechanism of injury and their unique biomechanical propensities following various forms of treatment can help the spinal surgeon manage such patients effectively and prevent devastating complications.