RSS-Feed abonnieren
![](/products/assets/desktop/img/oa-logo.png)
DOI: 10.4103/ajns.AJNS_115_20
One-stage posterior only corpectomy and fusion in the treatment of a unique acute low lumbar L4 burst fracture without neurologic deficit: A case presentation
![](https://www.thieme-connect.de/media/10.1055-s-00053244/202003/lookinside/thumbnails/10-4103-ajns-ajns-115-20_293700-1.jpg)
L4 and L5 fractures are different from those at the thoracolumbar area. These differences include anatomy, biomechanics, classification, and treatment possibilities. Given the accessible literature and lack of high-quality information about the management of low lumbar fractures, we describe the case of a young 26-year-old male was referred to our emergency medical center with a severe L4 vertebral body comminuted burst fracture with complete spinal canal compression (AO type 4). Incredible, all neurological functions were intact initially. The patient was cured through a one-stage posterior only vertebrectomy and fusion with preservation of all neurological functions. Clinical and radiologic follow-up was satisfactory after 2 years. In more severe lumbar injuries, decisions contain spinal decompression and stabilization through a posterior or anterior approach based on the surgeon's favorite. In our experience in this patient, a posterior approach only was used both for decompression and stabilization without routine challenging existing in anterior approaches.
Financial support and sponsorship
Nil.
Publikationsverlauf
Eingereicht: 26. März 2020
Angenommen: 29. April 2020
Artikel online veröffentlicht:
16. August 2022
© 2020. Asian Congress of Neurological Surgeons. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)
Thieme Medical and Scientific Publishers Pvt. Ltd.
A-12, 2nd Floor, Sector 2, Noida-201301 UP, India
-
References
- 1 Magerl F, Aebi M, Gertzbein SD, Harms J, Nazarian S. A comprehensive classification of thoracic and lumbar injuries. Eur Spine J 1994;3:184-201.
- 2 Sansur CH, Shaffrey CI. Diagnosis and management of low lumbar burst fractures. Semin Spine Surg 2010;22(1):33-7.
- 3 Islas DA, Jiménez Ávila JM. L4 fractures, biomechanics of cure foretold. Coluna Columna 2014;13:315-7.
- 4 An HS, Vaccaro A, Cotler JM, Lin S. Low lumbar burst fractures. Comparison among body cast, Harrington rod, Luque rod, and Steffee plate. Spine (Phila Pa 1976) 1991;16:S440-4.
- 5 Varlotta GP, Lefkowitz TR, Schweitzer M, Errico TJ, Spivak J, Bendo JA, et al. The lumbar facet joint: A review of current knowledge: Part 1: Anatomy, biomechanics, and grading. Skeletal Radiol 2011;40:13-23.
- 6 Su BW, Kim PD, Cha TD, Lee J, April EW, Weidenbaum M, et al. An anatomical study of the mid-lateral pars relative to the pedicle footprint in the lower lumbar spine. Spine (Phila Pa 1976) 2009;34:1355-62.
- 7 Vaccaro AR, Kepler CK, Rihn JA, Suzuki H, Ratliff JK, Harrop JS, et al. Anatomical relationships of the anterior blood vessels to the lower lumbar intervertebral discs. J Bone Joint Surg Am 2012;94:1088-94.
- 8 Kriek JJ, Govender S. AO-classification of thoracic and lumbar fractures-reproducibility utilizing radiographs and clinical information. Eur Spine J 2006;15:1239-46.
- 9 Schouten R, Fisher CG. Fusion for lower lumbar (L3-L5) fractures: Surgical indications and techniques. Semin Spine Surg 2011;23:249-56.
- 10 Al-Khalifa FK, Adjei N, Yee AJ, Finkelstein JA. Patterns of collapse in thoracolumbar burst fractures. J Spinal Disord Tech 2005;18:410-2.
- 11 Kingwell SP, Noonan VK, Fisher CG, Graeb DA, Keynan O, Zhang H, et al. Relationship of neural axis level of injury to motor recovery and health-related quality of life in patients with a thoracolumbar spinal injury. J Bone Joint Surg Am 2010;92:1591-9.
- 12 Aihara T, Takahashi K, Yamagata M, Moriya H. Fracture-dislocation of the fifth lumbar vertebra. A new classification. J Bone Joint Surg Br 1998;80:840-5.
- 13 Haddadi K, Yousefzadeh F. Epidemiology of traumatic spinal injury in North of Iran: A cross-sectional Study. IrJNS 2015;1.
- 14 Robertson PA. Fractures of L4 and L5 (Low Lumbar Fractures). Spineuniverse; 2012.
- 15 Oner FC, Wood KB, Smith JS, Shaffrey CI. Therapeutic decision making in thoracolumbar spine trauma. Spine (Phila Pa 1976) 2010;35:S235-44.
- 16 Heary RF, Salas S, Bono CM, Kumar S. Complication avoidance: Thoracolumbar and lumbar burst fractures. Neurosurg Clin N Am 2006;17:377-88, Viii.
- 17 Dai LY. Remodeling of the spinal canal after thoracolumbar burst fractures. Clin Orthopaed Related Res 2001;382:119-23.
- 18 Verlaan JJ, Diekerhof CH, Buskens E, van der Tweel I, Verbout AJ, Dhert WJ, et al. Surgical treatment of traumatic fractures of the thoracic and lumbar spine: A systematic review of the literature on techniques complications, and outcome. Spine 2004;29:803-14.
- 19 Dimar JR, Fisher C, Vaccaro AR, Okonkwo DO, Dvorak M, Fehlings M, et al. Predictors of complications after spinal stabilization of thoracolumbar spine injuries. J Trauma 2010;69:1497-500.