The Management and Functional Outcome of Isolated Burst Fractures of the Fifth Lumbar Vertebra

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Abstract

Study Design.

We retrospectively reviewed 14 cases of isolated burst fractures of the fifth lumbar vertebra (L5) presenting over a 10-year period to the National Spinal Injuries Unit (NSIU) of the Republic of Ireland.

Objectives.

The objective was to evaluate treatment outcomes in patients suffering isolated burst fractures of L5 without neurologic compromise managed operatively and nonoperatively.

Summary of Background Data.

Burst fractures of L5 represent a very small proportion of all spinal injuries. The unique anatomic and biomechanical characteristics of this region protect it from traumatic injury.

Methods.

Fourteen patients (n = 14) were managed for isolated burst fractures of L5 at the NSIU over a 10-year period. The Hospital Inpatient Enquiry System and the NSIU Database identified our study cohort. A retrospective analysis of the medical records, radiographs, and CT scans of all patients identified was performed. Loss of anterior vertebral height, degree of kyphotic deformity, and percentage retropulsion were recorded at several phases of treatment. Follow-up clinical evaluation was performed with respect to pain status, work and recreational restrictions, along with overall patient satisfaction.

Results.

Of the study cohort (n = 14), 10 patients were managed nonoperatively and 4 patients operatively. The nonoperative group showed a superior radiographic outcome at follow-up, with the nonoperative group showing a mean loss of anterior vertebral height of 15.7% and a mean kyphotic deformity of 10.4°. The operative group, in contrast, had a mean loss of anterior vertebral height of 19% and mean kyphotic deformity of 11° at follow-up. The nonoperative group additionally exhibited superior results at clinical follow-up regarding pain status, work and recreational restrictions, and overall satisfaction.

Conclusions.

In the largest series to date of isolated burst fractures of L5, we strongly advocate the nonoperative management of these injuries, particularly in cases of moderate bony deformity, minimal canal compromise, and no neurologic deficit.

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