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Abstract
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.
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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.
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.
Table 1.
Denis Pain and Work Scale
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