Korean J Neurotrauma.  2013 Oct;9(2):135-138. 10.13004/kjnt.2013.9.2.135.

Single Stage Posterior Lumbar-Sacral Reconstruction with Expendable Cage and Iliac Screw for Fifth Lumbar Fracture-Dislocation

• Choi WS
• Cho KS
• Lee SB
• Huh PW
• Yoo DS

• KMID: 2156115
• DOI: http://doi.org/10.13004/kjnt.2013.9.2.135

Abstract

Fracture-dislocations of the fifth lumbar vertebra are rare. Treatment of L5 vertebra fractures depends on fracture type and neurological findings. The authors describe a single-staged surgical technique of only posterior circumferential decompression, spinal reconstruction with expandable cage insertion and instrument fixation.

Keyword

Burst fracture; Expandable cage; Fracture-dislocation; Fifth lumbar vertebra

MeSH Terms

Decompression
Spine

Figure

• 

  FIGURE 1. A: Fracture of the fifth lumbar vertebra-lateral view. B: Fracture of the fifth lumbar vertebra-CT sagittal reconstruction.

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  FIGURE 2. A: AP view after stabilization L4-S1-alar screw and Synex expandable cage. B: Lateral view after stabilization. C: CT scan 1 year after operation (sagittal reconstruction) shows fully decompressed canal and the presence of fused anterior reconstruction.

Reference

References

1. Abdel-Fattah H, Rizk AH. Complete fracture-dislocation of the lower lumbar spine with spontaneous neurologic decompression. Clin Orthop Relat Res:140–143. 1990.

2. 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) 16 (8 Suppl):S440-S444. 1991.

3. Andreychik DA, Alander DH, Senica KM, Stauffer ES. Burst fractures of the second through fifth lumbar vertebrae. Clinical and radiographic results. J Bone Joint Surg Am. 78:1156–1166. 1996.

4. Bingol H, Cingoz F, Yilmaz AT, Yasar M, Tatar H. Vascular complications related to lumbar disc surgery. J Neurosurg 100 (3 Suppl Spine):249–253. 2004.

5. Blanco JF, De Pedro JA, Hernández PJ, Paniagua JC, Framiñán A. Conservative management of burst fractures of the fifth lumbar vertebra. J Spinal Disord Tech. 18:229–231. 2005.

6. Butler JS, Fitzpatrick P, Ni Mhaolain AM, Synnott K, O'Byrne JM. The management and functional outcome of isolated burst fractures of the fifth lumbar vertebra. Spine (Phila Pa 1976). 32:443–447. 2007.

7. Chan DP, Seng NK, Kaan KT. Nonoperative treatment in burst fractures of the lumbar spine (L2-L5) without neurologic deficits. Spine (Phila Pa 1976). 18:320–325. 1993.

8. Durward QJ, Schweigel JF, Harrison P. Management of fractures of the thoracolumbar and lumbar spite. Neurosurgery. 8:555–561. 1981.

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

10. Hunt T, Shen FH, Arlet V. Expandable cage placement via a posterolateral approach in lumbar spine reconstructions. Technical note. J Neurosurg Spine. 5:271–274. 2006.

11. 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. 11:435–440. 2002.

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

13. Mayer HM, Wiechert K, Korge A, Qose I. Minimally invasive total disc replacement: surgical technique and preliminary clinical results. Eur Spine J 11 Suppl. 2:S124–S130. 2002.

14. Mick CA, Carl A, Sachs B, Hresko MT, Pfeifer BA. Burst fractures of the fifth lumbar vertebra. Spine (Phila Pa 1976). 18:1878–1884. 1993.

15. Prasad VS, Vidyasagar JV, Purohit AK, Dinakar I. Early surgery for thoracolumbar spinal cord injury: initial experience from a developing spinal cord injury centre in India. Paraplegia. 33:350–353. 1995.

16. Sasani M, Ozer AF. Singlestage posterior corpectomy and expandable cage placement for treatment of thoracic or lumbar burst fractures. Spine (Phila Pa 1976). 34:E33–E40. 2009.

17. 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 (Phila Pa 1976). 24:2154–2161. 1999.

18. Suomalainen O, Pääkkönen M. Fracture dislocation of the lumbar spine without paraplegia. A case report. Acta Orthop Scand. 55:466–468. 1984.