Fractures of the Fifth Lumbar Vertebra

Česká verzia

Authors: M. Kelbl; J. Kočiš; S. Kazda; P. Wendsche
Authors place of work: Klinika traumatologie LF MU a Úrazová nemocnice v Brně
Published in the journal: Cesk Slov Neurol N 2010; 73/106(3): 274-278
Category: Krátké sdělení

Summary

Fractures of the fifth lumbar vertebra are rare injuries. Only few papers addressing this problem appear in the world literature. The objective of this paper is a retrospective evaluation of a group of patients who were treated for such fractures in our hospital over the past nine years. It covers 28 patients with fifth lumbar vertebra fracture, hospitalized in the Brno Traumatological Hospital in the nine‑year period. Surgical procedures were used for 23 patients, while treatment was conservative in five cases. Neurological deficit was observed in 13 patients at the time of admission; eight of them recovered normal neurological status. At the end of the follow‑up period, 15 patients were pain‑free, 10 patients complained of occasional pain and three patients recorded frequent pain. In the case of patients with normal neurological status and minimal compression of the vertebral body, we recommend a conservative approach to treatment. This is also preferable for burst fractures without instability. Surgery has only a negligible effect on the height of the vertebral body and the axis of the spinal column. In cases of neurological deficit we recommend operative treatment with decompression of neurological structures. In most cases we could expect significant improvements in neurological status.

Key words:
lumbar vertebrae –⁠ spinal fractures –⁠ treatment

Zdroje

1. Mick CA, Carl A, Sachs B, Hresko M, Pfeifer BA. Burst fracture of the fifth lumbar vertebra. Spine 1993; 18(13): 1878 –⁠ 1884.

2. 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 1999; 24(20): 2154 –⁠ 2161.

3. Šebesta P, Štulík J, Vyskočil T, Kryl J. Zadní stabilizace zlomenin L5 bez ošetření předního sloupce. Acta Chir Orthop Traumatol Cech 2008; 75 : 123 –⁠ 128.

4. Magerl F, Aebi M, Gertzbein SD, Harms J, Nazarian SA. Comprehensive classification of thoracic and lumbar injuries. Eur Spine J 1994; 3(4): 184 –⁠ 201.

5. Hrabálek L, Bučil J, Vaverka M, Houdek M, Krahulík D,Kalita O. Úskalí diagnostiky a léčby flekčně‑distrakčních poranění hrudní a bederní páteře: prospektivní studie. Cesk Slov Neurol N 2008; 71/ 104(2): 163 –⁠ 172.

6. Hrabálek L, Bučil J, Vaverka M, Houdek M, Krahulík D, Kalita O. Indikace přední náhrady meziobratlové ploténky u zlomenin hrudní a bederní páteře s využitím magnetické rezonance –⁠ prospektivní studie. Cesk Slov Neurol N 2009; 72/ 105(2): 132 –⁠ 140.

7. Kocis J, Wendsche P, Visna P. Complete burst fracture of the fifth lumbar vertebra treated by posterior surgery using expandable cage. Acta Neurochir (Wien) 2008; 150(12): 1301 –⁠ 1305.

8. Butler JS, Fitzpatrick P, Ni Mhaolain AM, Synnot K, O’Byrne JM. The management and functional outcome of isolated burst fractures of the fifth lumbar vertebra. Spine 2007; 32(4): 443 –⁠ 447.

9. Kaminski A, Müller EJ, Muhr G. Burst fracture of the fifth lumbar vertebra: results of posterior internal fixation and transpedicular bone grafting. Eur Spine J 2002; 11(5): 435 –⁠ 440.

10. Finn CA, Stauffer ES. Burst fracture of the fifth lumbar vertebra. J Bone Joint Surg Am 1992; 74(3): 398 –⁠ 403.

11. Blanco JF, De Pedro JA, Hernandez PJ, Paniagua JC, Framinan A. Conservative management of burst fractures of the fifth lumbar vertebra. J Spinal Disord Tech 2005; 18(3): 229 –⁠ 231.

12. Court –⁠ Brown CM, Gertzbein SD. The management of burst fractures of the fifth lumbar vertebra. Spine 1987; 12(3): 308 –⁠ 312.

13. Fredrickson BE, Yuan HA, Miller H. Burst fractures of the fifth lumbar vertebra. A report of four cases. J Bone Joint Surg Am 1982; 64(7): 1088 –⁠ 1094.

14. Aihara T, Takahashi K, Yamagata M, Moriya H. Fracture‑dislocation of the fifth lumbar vertebra. A new classification. J Bone Joint Surg 1998; 80(5): 840 –⁠ 845.

15. Boerger TO, Limb D, Dickson DA. Does “canal clearance” affect neurological outcome after thoracolumbar burst fractures? J Bone Joint Surg Br 2000; 82(5): 629 –⁠ 635.