Chance's fracture of the fourth lumbar vertebra

Khare, Ghanshyam Narayan; Kochhar, V. L.; Lal, Yash Mohan

doi:10.1016/0020-1383(89)90177-0

Cited by 2 publications

(1 citation statement)

References 3 publications

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“…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]. Nevertheless, lumbosacral anterior approach may be difficult due to major vessels (sometimes adherent to the injured vertebra) and lack of specific L4-S1 instrumentations [22]. Corpectomy and lateral plating across the lordotic segments can be technically demanding [8].…”

Section: Discussionmentioning

confidence: 99%

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%