Lumbar Fracture

Presentation

A 52-year-old man fell the height of one story a year ago. He has had chronic low back pain since then. His neurologic examination is normal.

Radiologic Findings

An L2 wedge fracture is seen on computed tomography (CT) reconstruction, with associated kyphosis (Fig. 11-1).

FIGURE 11-1 CT reconstruction of the lumbar spine with an L2 wedge compression fracture and kyphosis is seen.

Diagnosis

Wedge compression fracture

FIGURE 11-2 Postoperative anteroposterior (AP) x-ray reveals the fusion construct.

Treatment

A left-sided retroperitoneal approach was used for an L2 corpectomy with cage and plate stabilization (Fig. 11-2).

Discussion

Flexion compression fractures (wedge fracture) cause failure of the anterior column. They are the most common type of thoracic and lumbar fracture. Denis divides these fractures into four subtypes. They are listed by decreasing frequency: fracture of the superior end plate, fracture of both end plates with separation of the anterior body, fracture of the anterior surface with end plates intact, and fracture of the inferior end plate. These are usually stable fractures. Patients should receive analgesics and early mobilization.

Surgery is indicated if patients develop progressive kyphosis. Patients at risk to develop progressive kyphosis from a compression wedge fracture have a 50% loss of vertebral body height, over 30 degrees of angulation, or failure of the posterior column. Posterior column failure can also be iatrogenic in etiology, stemming from a previous laminectomy.

An anterior approach (retroperitoneal) can be used in thoracolumbar junction fractures to better decompress a stenosed canal, support the anterior column, and enhance fusion rate without incorporating a long-arm segment. Bicortical screw purchase is necessary to stabilize this junctional segment. The disadvantages are that the procedure carries a relatively high morbidity and is technically demanding.