Orthopaedics, The Don Gnocchi Foundation, Milan, Italy.
Eur Spine J. 2012 May;21 Suppl 1(Suppl 1):S119-22. doi: 10.1007/s00586-012-2226-y. Epub 2012 Mar 10.
We report our experience and literature review concerning surgical treatment of neurological burst fractures of the fifth lumbar vertebra.
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.
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.
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.
我们报告了我们在第五腰椎神经爆裂性骨折的手术治疗方面的经验和文献复习。
连续纳入 19 例 L5 神经爆裂性骨折患者；6 例患者存在完全运动功能障碍，12 例患者存在括约肌功能障碍。我们进行了 18 例后路和 1 例联合入路手术。为了避免后凸，在手术台上将患者的髋部和膝关节完全伸直，通过后路内固定来实现。在最近的随访（平均 22 个月，范围 10-66）时，评估了神经恢复、椎管重塑和 L4-S1 角度。
椎体置换困难，导致 cage 呈倾斜位。即使固定后可获得可接受的侧位（22°，范围 20-35），椎体仍保持变形。我们观察到 3 例瘫痪，5 例完全恢复，3 例不完全恢复。在其余 8 例患者中，只有括约肌损伤。在 15 例患者中，疼痛不存在或偶尔存在；在 4 例患者中，疼痛持续但不致残。X 线和/或 CT 可见重塑，无明显的继发性狭窄。
L5 爆裂性骨折很少见，主要由轴向压缩引起。马尾和/或神经根损伤是手术的绝对适应证。如果前路技术上困难，椎板切除术可以允许减压，并且可以很容易地与经椎弓根螺钉固定相结合。后路器械融合，也旨在恢复矢状位轮廓，如果与准确的椎管探查和减压相结合，可能被视为治疗神经 L5 爆裂性骨折的最佳方法。
