Complete rotational burst fracture of the third lumbar vertebra managed byposterior surgery - A case report

Study Design. Case report of a young man with rotational burst fracture of the third lumbar vertebra, treated by posterior surgery. Objectives. To describe the management of a rotational burst fracture of th e third lumbar vertebra by posterior surgery consisting of reduction, decom pression, fusion, and transpedicular instrumentation. Summary of Background Data. Surgery is the generally recommended means of m anaging lumbar burst fractures with neurologic deficit. Some surgeons recom mend anterior decompression, fusion, and instrumentation. Posterior surgery with decompression through laminectomy, spongioplasty of the vertebral bod y, interbody fusion of damaged discs, posterolateral fusion, and transpedic ular fixation is also a safe and successful management technique. The combi ned approach consists of posterior decompression, fusion, transpedicular fi xation, and anterior fusion using pelvic autografts. The optimum method of management remains in question. Method. An 18-year-old man with complete rotational burst fracture of the t hird lumbar vertebra was treated by posterior surgery. This surgery consist ed of reduction, laminectomy, decompression, suture of dural sac tears, spo ngioplasty of the vertebral body, interbody fusion of both damaged discs, a nd the implantation of a transpedicular Socon fixator (Aesculap, Tuttlingen , Germany), including a transverse connector. The case was documented by ra diographs and computed tomography scans before surgery and after fixator re moval 19 months after surgery. Results. The patient healed solidly with no instrumentation failure. The ne urologic deficit Frankel Grade B improved to Frankel Grade D. Conclusion. Surgery to manage lumbar burst fracture must include reduction, decompression, restoration and fusion of anterior and posterior elements b y using autologous pelvic spongious autografts, and anterior or posterior i nstrumentation. Posterior surgery including suturing of dural sac tears, fu sion of damaged structures, and transpedicular fixation is successful in yo ung patients and patients with good bone quality.