The radiographic characterization of burst fractures of the spine. Pedicle screws and rods from t12 to l2 were placed, and posterior and posterolateral arthrodesis from t12 to l2 was achieved using morcellized cortical cancellous bone, which was locally harvested autograft, and allograft bone. Fractures above l1 can be associated by spinal cord compression symptoms. There are seven vertebrae in the cervical spine neck, 12 vertebrae in the thoracic spine mid back, and 5 vertebrae in the lumbar spine lower back. Type a3 is a classification made by the radiologist at the time xrays are taken. Management of thoracolumbar fractures thieme connect. According to the spineuniversity website, there are approximately 700,000 cases of compression fractures related to osteoporosis yearly in the united states 2. Conserva tive management of thoracolumbar burst spine fractures in neurologically intact patients, with bracing and. There are seven vertebrae in the cervical spine neck, 12 vertebrae in the thoracic spine mid. The l1 vertebra is the topmost section of the lumbar spinal column. Overview epidemiologyepidemiology anatomyanatomy initial assessmentinitial assessment imagingimaging injury mechanismbiomechanicsinjury mechanismbiomechanics fracture classificationfracture classification treatment options. If a vertebra is crushed in all directions, the condition is called a burst fracture. Twentythree patients with burst fracture of the thoracolumbar and lumbar spine were treated nonoperatively.
In our series, the presence of a preoperative neurological deficit in a patient who had a burst fracture and an associated laminar fracture was a sensitive 100 per cent and specific 74 per cent. The fracture line breaches both the anterior and posterior vertebral body cortex and the anterior superior endplate. Longterm radiological and clinical outcome retrospective study of surgical treatment for t12 and l1 burst fractures in perspective of sagittal balance measures. In these patients, treatment with a brace may lead to an excellent result. The patient underwent an open reduction of the unstable l1 burst fracture with internal fixation of the vertebra. Diagnosis and management of vertebral compression fractures. Any injury that changes the shape of a lumbar vertebra will alter the lumbar posture, increasing or decreasing the lumbar curve. She has written professionally for more than seven years. In this biomechanical cadaver study twentyeight spine segments t11l3 were used male donors, mean age 64. That being said, the majority of patients with a burst fracture of the spine without neurologic deficit will go on. Spinal injury burst fractures of l1 vertebra,spinal injury burst fracture of l1 vertebra. Its been 3 months to the day since i got into a major car accident and i broke my back.
I have a 60% l1 compression fracture that happened as a result from a fall from a ladder about 6 feet. A burst fracture is an injury in which the vertebra, the primary bone of the spine, breaks in multiple directions. Decisionmaking in burst fractures of the thoracolumbar. Other diseases and conditions, such as parathyroid gland disorders and various cancers, may also. The management of thoracolumbar fractures continues to evolve. Spinal fractures classification system an aospine knowledge forum initiative. Fiftyfive patients presenting with thoracolumbar fractures between.
Spinal disabilities whether acquired or congenital pose significant challenges in management and decisionmaking. If the bone collapse is gradual such as a fracture. Pdf classification of radiological changes in burst. L1 compression fracture recovery answers on healthtap. Methods this is a single center, retrospective study. Acute l1 burst compression fracture radiology case. The definition of a fracture is a complete or partial interruption of the continuity of the bone. Spinal injury burst fractures of l1 vertebra stock. The bones spread out in all directions and may damage the spinal cord. In general, a stable burst fracture is one in which there is no neurologic injury, in which the angulation of the spine is less than 20 degrees and in which the amount of spinal canal compromise is less than 50 percent. A stable burst fracture may be treated without surgery. If the fracture is caused by a sudden, forceful injury, you will probably feel severe pain in your back, legs, and arms. The fracture anatomy was evaluated routinely by xray and ct scan. Mri shows mild vertebral retropulsion with 10% central canal stenosis and no evidence of injury to the posterior ligament complex.
Burst fractures are much more severe than compression fractures. The radiographic characterization of burst fractures of. Burst fractures are the result of compression and flexion. The purpose of physical therapy management in patients with lumbar spine fracture is to decrease pain, increase mobility and prevent future occurances. The primary aims of this study were to assess different levels of fixation with respect to radiological outcomes in terms of fracture reduction and future loss of correction. You can feel the spinous process, a projection from this arch, when. Type c are any type of fracture that is accompanied by displacement in the sagittal or coronal plane.
Doctor answers on symptoms, diagnosis, treatment, and more. Pdf conus medullaris syndrome without lowerextremity. A burst fracture is a very serious fracture of a vertebrae the bones that make up our spine. Is a back brace really needed for a burst fracture of the. Fractures of the thoracic and lumbar spine orthoinfo aaos. The aim of the study is to evaluate the purpose of additional percutaneous intravertebral reduction when combined with dorsal instrumentation. I wore a brace for about 8 weeks and im currently in physical therapy 2 days a week and i feel pretty good for the most part except i get uncomfortable easily and my back feels pretty tight almost 247 which. Decision making in thoracolumbar fractures bioline international. Because of the infrequency of these fractures, only a limited number of reports exist on their optimal management. Direct reduction of thoracolumbar burst fractures by means o. Operative compared with nonoperative treatment of a. The fracture line breaches both the anterior and posterior vertebral body. Between 1986 and 1992, 32 thoracolumbar fractures in 32 patients were treated nonoperatively with 46 weeks on a rotorest bed followed by bracing with a thoracolumbosacral orthosis for a.
Vertebral reconstruction with biodegradable calcium phosphate cement in the treatment of osteoporotic vertebral compression fracture using instrumentation. Transverse process fractures are predominantly treated with gradual increase in motion, with or without bracing, based on comfort level. You might also feel weakness or numbness in these areas if the fracture injures the nerves of the spine. Lumbar burst fracture associated with bowel, bladder, and. A compression fracture is a condition in which a vertebra is crushed only in the front part of the spine, causing a wedge shape. Evidencebased management of traumatic thoracolumbar burst. There has been substantial controversy related to the indications for nonoperative or operative management of these fractures. T12l1 type b2 with t12 a4 according to the combination rules. This article focuses on fractures of the thoracic spine midback and lumbar spine lower back that result from a highenergy event, such as a car crash or a fall from a ladder. Direct reduction of thoracolumbar burst fractures by means. I had an l1 burst and had 2 metal rods placed from the t11 l3 and 8 screws as well in my back.
Compression fractures arise from a flexion injury, with no greater than 25% compression of the middle column and no injury to the posterior longitudinal ligament. Twentythree consecutive patients with an average age of 48 years, who sustained thoracolumbar a3type burst fracture with or without neurologic deficit were. Vertebral compression fractures vcfs are the most common complication of osteoporosis, affecting more than 700,000 americans annually. Burst compression fracture of the l1 vertebral body is associated with 35% loss of vertebral body height. Decisionmaking in burst fractures of the thoracolumbar and. Clearly shows the retropulsion of bone fragments into the spinal canal with impingement of the spinal cord causing partial paralysis. The authors report four cases of l1 burst fractures in which conus medullaris dysfunction was the sole. A compression fracture of the lumbar spine is also. Functional outcome of burst fractures of the thoracolumbar spine managed.
Lumbar compression fractures university of maryland. Denise stern is an experienced freelance writer and editor. Introduction management of thoracolumbar fractures remains controversial in the literature. I had a spinal burst fracture of my second lumbar vertebrae as well as fractures of the third and fifth lumbar vertebrae. When chronic pain from a spinal compression fracture persists despite rest, activity modification, back bracing, and pain medication, surgery is the next step. There were 29 fractures 37% involving t12, 41 fractures 53% involving l1, and 8 fractures 10% involved l2. Typical features of the burst fracture sagittal vertebral body fracture. Rarely does an isolated conus medullaris injury occur from an extradural cause without other neurological deficits. Eligibility criteria included all of the following. Burst fractures of the lower lumbar spine l4 and l5 account for approximately 1% of all lumbar fractures, and most often result from highimpact trauma. Though common, thoracolumbar and lumbar burst fractures present a number of important treatment challenges. Stern regularly provides content for healthrelated and eldercare websites and has an associate and specialized business degree in health information management and technology. There is a little canal compromise by the retropulsed fragment. Burst fracture the spine hospital at the neurological.
Fracture risk increases with age, with four in 10 white. Director of spine trauma, metrohealth medical center. Compression fractures are caused by pressure placed against the vertebrae due to lack of disc cushioning between the spinal bones, often caused by conditions like arthritis and osteoporosis. My orthopedic surgeon used a portion of my hip bone as well as synthetic bone to create a new l2 vertebrae. Injuries to the l1 spine can affect hip flexion, cause paraplegia, loss of bowelbladder control, andor numbness in the legs. Burst fracture involving a single endplate with involvement of the posterior vertebral wall. A burst fracture is a type of traumatic spinal injury in which a vertebra breaks from a highenergy axial load e. The total cohort confirmed a preinjury odi score of 0, and had a single level spinal fracture at t12, l1 or l2, with a local kyphosis greater than 20. Sixtysix of 75 burst fractures 88% had a typical vertically oriented fracture com ponent in the vertebral body, involving the inferior half of the vertebra and extending to the region of the basivertebral foramen. Lumbar compression fractures university of maryland medical. Among these 23 patients, had a neurological deficit and 10 patients did not have.
Fracture dislocations of the thoracic and lumbar spine are caused by very highenergy trauma. Bony injury to the lower cervical area occurs in the form of compression fracture, burst fracture, or teardrop fracture. Ideally, it should effectively correct the deformity, induce neurological recovery, allow early mobilization and return to work. Jul 02, 20 l1 burst fracture with neurologic deficit. Burst fractures of the spine account for 14% of all spinal injuries. May be customized by editing labels, or by combining artwork with graphics from our 15,000 image library.
The incidence of vertebral fractures is difficult to quantify accurately, as only a third of patients come to medical attention after fracture. These types of fractures are typically medical emergencies that require urgent treatment. The youngest was 18 years and oldest was 53 years of age at the time of injury. If the bone collapse is gradual such as a fracture from bone thinning, the pain will usually be milder. The lumbar spine provides stability and support for the whole upper body. A lumbar compression fracture is located in the lower portion of the spine. Ligament injury or fracture fragment compression on the spinal cord or nerve roots may require surgical decompression with or without stabilization. Management of burst fractures in the thoracolumbar spine. Of note is a burst fracture of l1 with loss of height by 50% but no kyphosis. Burst fracture definition of burst fracture by medical. Patients with age of 1660 years, complete radiographs, early surgical treatment surgery, and followup fu 18 months were included and strict exclusion criteria applied. It varies in part on some other characteristics of the fracture, such as for example the overall alignment of the spine and the degree of stenosis of the neural canal. Below are the patients initial lateral figure 1 and axial figure 2a, 2b ct scans. What is a fair settlement amount of money for a l1 burst.
A burst fracture is caused by axial compression and accompanied with retropulsed bone fragments into spinal canal. Main causes of fractures in the thoracolumbar spine are. This section of the spine contains a portion of the spinal cord. Dramatically depicts a crushed l1 vertebral fracture. Fiftyfive patients presenting with thoracolumbar fractures between january.
Percutaneous dorsal instrumentation of vertebral burst. The most common fractures in the spine take place in the. Thoracolumbar burst fracture in patients with neurological deficit. Operative management of unstable thoracolumbar burst fractures. The management of thoracolumbar burst fractures remains challenging. A frequent cause of spinal compression fractures is osteoporosis, which is a bone thinning and weakening disease 2. Compression fractures are either caused by osteoporosis or trauma.
The burst fracture is a specific form of compression fracture of the vertebral body wherein a fragment arising from the posterosuperior margin of the vertebral body is displaced into the spinal canal. Most spine fractures will heal with rest and spine support brace. Preoperative neurological state according to asia motor index was a in 6 cases, b in 28 cases, c in 26 cases and d in 20 cases. Management of burst fractures in the thoracolumbar spine ncbi. Conus medullaris injury from burst fractures is known to occur in conjunction with other neurological deficits, including lowerextremity motor weakness or sensory changes. Pdf management of burst fractures in the thoracolumbar spine. The vertebral arch is a ringshaped section that forms the roof of the spinal canal and protects the spinal cord. Further below are the patients initial lateral figures 3a3c and axial mr images. Consultation with a specialist in cervical spine injuries is indicated. Nonoperative treatment of thoracolumbar fractures spinal cord. It is a specific designation letting the medical doctor know that the patient has a burst fracture as opposed to some other type of fracture e. Operative management of unstable thoracolumbar burst.
The treatment of vertebral burst fractures is still controversial. A comparison of three different methods of fixation in the. An analysis of conservative nonsurgical management of thoracolumbar fracture and fracture dislocation with neural damage. This happened about 4 months ago at a close friends house while building a.
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