Journal List > J Korean Soc Spine Surg > v.17(1) > 1075922

Kim, Lee, Kang, Chung, Lee, and Han: 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±3.2° to 7.6±2.4° postoperatively and 9.7±4.3° 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 1.27° 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.

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Fig. 1.
A 58 year old man sustained burst fracture at L3. (A) Initial kyphotic angle is 22.8 degree. (B) Postoperative kyphotic angle is corrected up to 4.2 degree. (C) 3 years follow-up radiograph shows 5.2 degree of kyphotic angle.
jkss-17-7f1.tif
Fig. 2.
Preoperative (A) and postoperative (B) CT images of L3 burst fracture. Preoperative CT scan shows retropulsed fragment into the spinal canal. The fragments are reduced into body and canal is restored.
jkss-17-7f2.tif
Table 1.
Denis Pain and Work Scale
P1 No pain
P2 Occaisional minimal pain, no need for medication
P3 Moderate pain, occaisional medication
No interruption of work or significant change in activities of daily living
P4 Moderate to severe pain, frequent medication
Occasional absence from work or significant change in activities of daily living
P5 Constant or severe incapacitating pain, chronic medication
W1 Returned to previous employment
W2 Able to return to previous employment
Returned to heavy labor full time with job modification
W3 Unable to return to previous employment
Work full time at a new job
W4 Unable to return to previous employment
Work part-time or frequently absence from work
W5 No work
Completely disabled
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