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. 2006 Aug;30(4):295-8.
doi: 10.1007/s00264-005-0052-0. Epub 2006 Feb 24.

Importance of greenstick lamina fractures in low lumbar burst fractures

C Ozturk  1 , S Ersozlu, U Aydinli
Affiliations

Importance of greenstick lamina fractures in low lumbar burst fractures

C Ozturk et al. Int Orthop. 2006 Aug.

Abstract
in English, French

Lumbar burst fractures (L3-L5) represent a small percentage of all spinal fractures. The treatment of fractures involving the lumbar spine has been controversial. Lamina fractures may be complete or of the greenstick type. Dural tears and nerve root entrapment may accompany these lamina fractures. The aim of this retrospective study was to determine the incidence of dural tear in patients who had lumbar burst fractures with greenstick lamina fractures and the importance of these lamina fractures when choosing the optimum treatment. Twenty-six patients with 28 lumbar burst fractures were treated from 1995 through 2002. The average follow-up was 60 months (range 32-110 months). The male to female ratio was 21:5 and the mean age was 37 years (17-64). Dural tear was detected in seven (25%) out of 28 burst fractures. The functional outcome of the entire study group was assessed using the Smiley-Webster Scale. Good to excellent results were obtained in 24 (92%) of 26 patients. Lumbar burst fractures with greenstick lamina fractures occur mostly in the L2-L4 area. In the surgical treatment, any reduction manoeuvre will close the fracture and crush the entrapped neural elements. Therefore, it may be better to explore the greenstick lamina fracture whether there is any neural entrapment or not, before any reduction manoeuvre is attempted.

Les fractures de la colonne lombaire basse représentent un petit pourcentage de toutes les fractures du rachis. Le traitement de ces fractures est controversé. Les fractures des arcs postérieurs peuvent être complètes ou en «bois vert». Des plaies durales ou des racines nerveuses peuvent être concomitantes de ces fractures. Le but de cette étude rétrospective a été de déterminer l’incidence des lésions durales chez les patients présentant une fracture lombaire basse, avec lésions des arcs postérieurs en «bois vert», de poser des indications sur le traitement optimum de ces fractures. Vingt-six patients avec 28 fractures basses ont été traités de 1995 à 2002. Le suivi de ces patients a été de 60 mois (32 à 110 mois), avec une prédominance masculine (5 femmes pour 21 hommes) et un âge moyen de 37 ans (17 à 64 ans). Des lésions durales ont été détectées chez 7 patients (25% des 28 fractures). Le résultat fonctionnel de tout le groupe a été analysé selon l’échelle de Smiley-Webster. Les résultats ont été bons ou excellents dans 92% des cas (24 des 26 patients). Le traitement des fractures lombaires basses avec lésions des arcs postérieurs incomplets en «bois vert» est surtout fréquent en L2, L3, L4. Le traitement chirurgical doit permettre de fixer les fractures lamaires et de libérer les éléments neurologiques. Pour cette raison nous recommandons d’explorer les fractures en «bois vert» des arcs postérieurs qu’il y ait ou non des lésions neurologiques et avant toute manœuvre de réduction.

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Figures

Fig. 1
Fig. 1
a A 32-year-old man with an L2–L3 burst fracture (with neurological deficit) with green stick lamina fracture at both sites. Open book laminoplasty was performed and b dural tear with nerve root entrapment was c repaired. d, e The patient is neurologically intact after 3 years’ follow-up
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