Treatment Outcome of Lower Lumbar Fracture with Neurological Deficit

ABSTRACT

STUDY DESIGN: A retrospective study. OBJECTIVES: To evaluate the clinical results of surgical treatment for a lower lumbar fracture with a neurological deficit. SUMMARY OF LITERATURE REVIEW There are several methods for treating lower lumbar fractures with neurological deficits but no definitive guidelines have been established. MATERIALS AND METHODS: From 2000 to 2008, this study reviewed 26 patients who had undergone surgery to treat a lower lumbar fracture with a neurological deficit and could be followed up for more than 12 months. The changes in the kyphotic angle, changes in the vertebral body height, compromise ratio of the spinal canal, recovery of neurological deficit, and clinical results were evaluated. RESULTS: There were 15, 7 and 4 cases with a third, fourth and fifth lumbar fracture, respectively. There are 19, 2 and 5 cases of an unstable bursting fracture, chance fracture and translational injury, respectively. The compromise ratio of the spinal canal improved from 67.2+/-9.4% to 16.4+/-4.6%, and the changes in the kyphotic angle improved from 14.5+/-3.2degrees to 7.6+/-2.4degrees postoperatively and 9.7+/-4.3degrees at the last follow-up. The changes in the vertebral body height improved from 41.3+/-8.4% to 23.4+/-6.3% and the bone union rate was 92.3%. The neurological deficit recovered with 1.27degrees according to the Frankel classification and good functional results were obtained in 84.6% of cases. CONCLUSIONS: Recovery of the neurological deficit and good clinical results were obtained with the recovery of the kyphotic angle and bone union with posterior decompression and instrumented posterolateral fusion in lower lumbar fractures with a neurological deficit.