title: Neurological L5 burst fracture: posterior decompression and lordotic fixation as treatment of choice.
abstract: OBJECTIVE
  We report our experience and literature review concerning surgical treatment of neurological burst fractures of the fifth lumbar vertebra.
  
  
  METHODS
  Nineteen patients with L5 neurological burst fractures were consecutively enrolled; 6 patients had complete motor deficits, and 12 had sphincter dysfunction. We performed 18 posterior and one combined approaches. To avoid kyphosis, posterior internal fixation was achieved by positioning patients on the operating table with hips and knees fully extended. At the latest follow-up (mean 22 months, range 10-66), neurological recovery, canal remodeling and L4-S1 angle were evaluated.
  
  
  RESULTS
  Vertebral body replacement was difficult, which therefore resulted in an oblique position of the cage. Vertebral bodies still remained deformed, even though fixation allowed for an acceptable profile (22°, range 20-35). We observed three cases of paralysis, five complete, and three incomplete recoveries. In the remaining eight patients, sphincter impairment was the only finding. In 15 patients, pain was absent or occasional; in four individuals, it was continuous but not invalidating. Remodeling was visible by X-ray and/or CT, without significant secondary stenosis.
  
  
  CONCLUSIONS
  The L5 burst fractures are rare and mostly due to axial compression. Cauda and/or nerve root injuries are absolute indications for surgery. If an anterior approach is technically difficult, laminectomy can allow for decompression, and it can be easily combined with transpedicular screw fixation. Posterior instrumented fusion, also performed with the aim to restore sagittal profile, when associated with an accurate spinal canal exploration and decompression, may be looked at as an optimal treatment for neurological L5 burst fractures.
authors.affiliation: Orthopaedics, The Don Gnocchi Foundation, Milan, Italy. alexramieri@libero.it
authors.forename: Alessandro
authors.initials: A
authors.lastname: Ramieri
authors.forename: Maurizio
authors.initials: M
authors.lastname: Domenicucci
authors.forename: Paolo
authors.initials: P
authors.lastname: Cellocco
authors.forename: Antonino
authors.initials: A
authors.lastname: Raco
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Costanzo
mesh_terms: D000328:Adult; D019299:Decompression, Surgical / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D005593:Fracture Fixation, Internal / Q000379:methods*; D006801:Humans; D008141:Lordosis / Q000000981:diagnostic imaging / Q000601:surgery*; D008159:Lumbar Vertebrae / Q000000981:diagnostic imaging / Q000293:injuries* / Q000601:surgery; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012447:Sacrum / Q000000981:diagnostic imaging / Q000601:surgery; D016103:Spinal Fractures / Q000000981:diagnostic imaging / Q000601:surgery*; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome