Management of Burst Fractures of the Low Lumbar Vertebra(L4-5)

ABSTRACT

A retrospective review of 14 patients treated non-operatively or operatively for burst fractures of the low lumbar spine(L4-L5) between January 1992 and December 1997 was performed. Burst fractures of the low lumbar spine are rare and have not been well delineated in the literature. Average follow-up period for fourteen patients was 10.6 months. Ten patients were men and four were women. The average age at injury was 36.8 years(range 17-70 years). Seventy-one percent of the injuries were the result of fall from height and 29% were the result of motor vehicle accidents. Non-operatively treated six patients were presented with minimal canal compromise and minimal or no initial neurological deficit. They were treated 4-6weeks of bed rest before they were allowed to mobilize with orthosis. None of these patients had any significant complications. If patients showed neurological impairment associated with significant canal compromise or vertebral height loss, they were treated operatively to restore spinal stability and spinal height and also to decompress neural elements. Various types of combined surgical approaches were used for eight patients who met these criteria. Among these, two were treated in a staged fashion with the anterior transperitoneal approach done initially. Vertebrectomy and complete neural decompression in direct vision was possible and interbody fusion was performed using Mesh cage, which was filled with bone collected from sites of vertebrectomy. This combined approach seems to be the choice of procedure for complete decompression and interbody fusion of the low lumbar burst fracture(L4-L5) with severe canal compromise and vertebral height loss. Transperitoneal approach for the low lumbar vertebrectomy has advantage of less muscular damage compared to retroperitoneal approach. There were no major complications from surgery in the present series.