Journal of Korean Neurosurgical Society

The Korean Neurosurgical Society (대한신경외과학회)
권호 표지
DOI QR코드

DOI QR Code

Screw Fixation without Fusion for Low Lumbar Burst Fracture : A Severe Canal Compromise But Neurologically Intact Case

  • Jang, Kun-Soo (Department of Neurosurgery, College of Medicine, Chosun University) ;
  • Ju, Chang-Il (Department of Neurosurgery, College of Medicine, Chosun University) ;
  • Kim, Seok-Won (Department of Neurosurgery, College of Medicine, Chosun University) ;
  • Lee, Sung-Myung (Department of Neurosurgery, College of Medicine, Chosun University)
  • Received : 2010.01.07
  • Accepted : 2011.01.13
  • Published : 2011.02.28
Download PDF
⟨ Previous Next ⟩

Abstract

The low lumbar spine is deeply located in flexible segments, and has a physiologic lordosis. Therefore, burst fractures of the low lumbar spine are uncommon injuries. The treatment for such injuries may either be conservative or surgical management according to canal compromise and the neurological status. However, there are no general guidelines or consensus for the treatment of low lumbar burst fractures especially in neurologically intact cases with severe canal compromise. We report a patient with a burst fracture of the fourth lumbar vertebra, who was treated surgically but without fusion because of the neurologically intact status in spite of severe canal compromise of more than 85%. It was possible to preserve motion segments by removal of screws at one year later. We also discuss why bone fusion was not necessary with review of the relevant literature.

Keywords

References

  1. An HS, Simpson JM, Ebraheim NA, Jackson WT, Moore J, O'Malley NP : Low lumbar burst fractures: comparison between conservative and surgical treatments. Orthopedics 15 : 367-373, 1992
  2. Chan DP, Seng NK, Kaan KT : Nonoperative treatment in burst fractures of the lumbar spine (L2-L5) without neurologic deficits. Spine 18 : 320-325, 1993 https://doi.org/10.1097/00007632-199303000-00002
  3. de Klerk LW, Fontijne WP, Stijnen T, Braakman R, Tanghe HL, van Linge B : Spontaneous remodeling of the spinal canal after conservative management of thoracolumbar burst fractures. Spine 23 : 1057-1060, 1998 https://doi.org/10.1097/00007632-199805010-00018
  4. el Masry WS, Short DJ : Current concept : spinal injuries and rehabilitation. Curr Opin Neurol 10 : 484-492, 1997 https://doi.org/10.1097/00019052-199712000-00009
  5. Finn CA, Stauffer ES : Burst fractures of the fifth vertebra. J Bone Joint Surg Am 74 : 398-403, 1992 https://doi.org/10.2106/00004623-199274030-00011
  6. Kim HS, Park SK, Joy H, Ryu Jk, Kim SW, Ju CI : Bone cement augmentation of short segment fixation for unstable burst fracture in severe osteoporosis. J Korean Neurosurg Soc 44 : 8-14, 2008 https://doi.org/10.3340/jkns.2008.44.1.8
  7. Kostuik JP : Anterior fixation for burst fractures of the thoracic and lumbar spine with or without neurological involvement. Spine 13 : 286-293, 1988 https://doi.org/10.1097/00007632-198803000-00011
  8. Kraemer WJ, Schemitsch EH, Lever J, McBroom RJ, McKee MD, Waddell JP : Functional outcome of thoracolumbar burst fractures without neurological deficit. J Orthop Trauma 10 : 541-544, 1996 https://doi.org/10.1097/00005131-199611000-00006
  9. Mohanty SP, Venkatram N : Does neurological recovery in thoracolumbar and lumbar burst fractures depend on the extent of canal compromise? Spinal Cord 40 : 295-299, 2002 https://doi.org/10.1038/sj.sc.3101283
  10. Okuyama K, Abe E, Chiba M, Ishikawa N, Sato K : Outcome of anterior decompression and stabilization for thoracolumbar unstable burst fractures in the absence of neurologic deficits. Spine 21 : 620-625, 1996 https://doi.org/10.1097/00007632-199603010-00016
  11. Saifuddin A, Burnett SJ, White J : The variation of position of the conus medullaris in an adult population. A magnetic resonance imaging study. Spine 23 : 1452-1456, 1998 https://doi.org/10.1097/00007632-199807010-00005
  12. Seybold EA, Sweeney CA, Fredrickson BE, Warhold LG, Bernini PM : Functional outcome of low lumbar burst fractures. A multicenter review of operative and nonoperative treatment of L3-L5. Spine 24 : 2154-2161, 1999 https://doi.org/10.1097/00007632-199910150-00016
  13. Yazar T, Cebesoy O, Soydan C, Köse C : Acute burst fracture of the low lumbar vertebra managed by anterior surgery. Journal of Ankara Medical School 26 : 41-45, 2004

Cited by

  1. Short Segment Screw Fixation without Fusion for Unstable Thoracolumbar and Lumbar Burst Fracture : A Prospective Study on Selective Consecutive Patients vol.51, pp.4, 2011, https://doi.org/10.3340/jkns.2012.51.4.203
  2. Short Segment Screw Fixation without Fusion for Low Lumbar Burst Fracture: Severe Canal Compromise but Neurologically Intact Cases vol.9, pp.2, 2011, https://doi.org/10.13004/kjnt.2013.9.2.101
  3. Implant Removal after Percutaneous Short Segment Fixation for Thoracolumbar Burst Fracture : Does It Preserve Motion? vol.55, pp.2, 2011, https://doi.org/10.3340/jkns.2014.55.2.73