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Burst Fracture of the Lumbar Spine



General Considerations

  • Burst fractures result from axial loading most often secondary to motor vehicle accidents and falls
  • The axial load drives the intervertebral disk into vertebral body below
  • Usually produces a comminuted, vertical fracture through the vertebral body
  • Fragments may be retropulsed into the spinal canal injuring the cord
  • Burst fractures may resemble flexion-teardrop fractures
    • In a classical flexion-teardrop fracture, there is an avulsed anterior, inferior triangular bony fragment that is displaced anteriorly
    • Both the anterior and posterior ligamentous structures are injured, which may not be the case in a burst fracture
      • Burst fractures, however, can have associated injury to the posterior ligamentous structures, especially if there is a combination of axial loading and flexion at the time of injury
  • Most common site of injury to the spine is the thoracolumbar junction

Clinical Findings

  • Back pain
  • Numbness or parasthesia
  • Weakness

Imaging Findings

  • On conventional radiography
    • Lateral view of the spine on conventional radiograph should show a comminuted fracture of the vertebral body
    • The anterior portion of the body will be wedged
    • Retropulsion can be inferred if the posterior surface of the vertebral body is convex towards the spinal canal, as the normal cervical vertebral body has a concave posterior surface
    • Injury to the posterior ligamentous structures can be inferred by forward subluxation of the fractured body on the one below it
  • CT will show the comminuted fracture and the retropulsed fragment and provide additional information on the compromise of the spinal canal

Treatment

  • Some controversy exists as to best treatment
  • Large number of thoracolumbar and lumbar fractures can be treated conservatively while some fractures require surgery
  • Principles of treatment include neural decompression, stabilization and fusion
  • Unstable fractures include a neurologic deficit
    • Loss of 50% of vertebral body height
    • Fracture associated with dislocation
    • Thoracolumbar burst fracture: angulation of the thoracolumbar junction > 20 degrees or canal compromise > 30 percent

Burst Fracture of Lumbar Spine. Sagittal reconstruction of CT of the lumbar spine demonstrates a comminuted vertical burst fracture through the body of L1 (white arrow). The posterior surface of L1 is displaced posteriorly toward the spinal canal (yellow arrow).
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