Low Lumbar Burst Fractures: Comparison Between Conservative and Surgical Treatments

Abstract

Twenty-two low lumbar burst fractures (L3-L5) were treated, with an average follow up of 56.2 and 39.0 months in the conservative and surgically treated groups, respectively. Twenty patients were available for review; seven were treated conservatively and 13 were stabilized surgically. All patients were evaluated clinically for work status, activity level, residual pain, and subsequent development of neurologic symptoms. Roentgenograms were reviewed for severity of initial fracture, canal compromise, and maintenance of initial correction. In general, neurologically intact patients in both groups returned to similar postinjury employment levels. Persistent back pain was found to be more disabling in the surgically treated group, in which a fusion incorporating four or five lumbar segments was performed. There was no evidence of significant loss of initial reduction, and no patients experienced late neurological compromise in the surgical group. An average follow-up kyphosis of 9.2° and 31% loss of vertebral height were observed in the conservative group, while a follow-up lordosis of 1° and 19% loss of vertebral height were observed in the surgical group. Conservative treatment of low lumbar burst fracture is a viable option in neurologically intact patients, but loss of lordosis and vertebral height may persist. Biomechanical and anatomic characteristics of the low lumbar spine differ from the thoracolumbar region and may account for the inherent stability of these injuries. If surgery is chosen, a long fusion with distraction instrumentation should be avoided in the low lumbar spine. A short rigid fixation with pedicular instrumentation may be of greater benefit.

Long-Segment Versus Short-Segment Pedicle Screw Fixation Including Fractured Vertebrae for the Management of Unstable Thoracolumbar Burst Fractures

“…SSPF has recently gained popularity due to a theoretical reduction in surgery time and implant expenses and the potential to save more motion segments [ 23 , 30 , 31 ]. According to some studies, SSPF is the best option for flatback disorder and loss of lumbar lordosis [ 32 ]. In addition, the main drawbacks of the procedure were insufficient lengthy reduction and instrumentation failure with postoperative kyphosis [ 33 ].…”

The late-term results in our patients operated for lumbar spine fractures

“…Verlaan et al (29) has reported that surgical treatment of traumatic spine fractures is safe and effective. In their studies An et al (30) and Smith et al (31) has stated that short rigid fixation with pedicular instrumentation is more beneficial in surgical treatment of spine fractures. There are also different studies (32)(33)(34)(35) in the literature that support the research results and draw attention to the safety of the use of short-segment pedicle instrumentation.…”

Short-Segment Pedicle Fixation of Traumatic Low Lumbar Fractures (L3–L5)

“…In 1992, An et al 6 compared conservative and surgical treatment of low lumbar burst fractures. This study concluded that the use of long segment instrumentation and fusion in treating these injuries should be avoided and that many of these fractures are amenable to conservative therapy, especially if the patient is neurologically intact.…”

“…3). Pain levels were classified as either none, mild, moderate, or severe, a scale previously used in examining low lumbar fractures, 6 and determined by the patients' reports in clinic at final follow-up.…”