Learning Radiology xray montage

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


  • 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).
For this same photo with the arrows, click
For more information, click on the link if you see this icon