Clinical Analysis Of 30 Patients With Low Lumbar Spinal Fractures

Background and objectives. Fractures of the low lumbar spine (L3-L5)represent a small percentage of all spine fractures. By comparing low lumbar spinal fractures with thoracolumbar spinal fractures, and comparing anterior approach with posterior approach, to emphasize the unique characteristics and treatment of low lumbar spinal fractures.Methods. Thirty patients with low lumbar spinal fractures were treated from2004 through 2006. Of these, there were 5 compression fractures, 22 burst fractures, 1 flexion-distraction fracture and 1 fracture-dislocation. One patient had a complete neurological lesion, 10 sustained an incomplete neurological injury, and 19 were neurologically intact. Two patients were treated non-operatively and 28 underwent surgery, including 9 anterior approach, 17 posterior approach and 2 anterior-posterior combined approach. The neurofunction was evaluated with Frankel system and the clinical outcomes were evaluated according to Denis Work and Pain Scales.Results. All patients were followed up for 3 months - 3years. No nailing failurewas observed in the fixation. All 10 patients who were incomplete neurological injury were recovered 1～2 Frankel grade. There were no differences in pain and the abilityto return to work between patients treated by anterior approach and posterior approach (p>0.05).Conclusions. Because of the unique anatomy and biomechanics, fractures of thelow lumbar spine are different from those in the remaining regions of spine. Most of low lumbar spinal fractures are unstable, and therefore surgery should be performed by posterior approach with short segmental pedicle screw system. If the Load-sharing of low lumbar spinal fractures is 7～9, anterior approach is indicated.