Screw Fixation without Fusion for Low Lumbar Burst Fracture : A Severe Canal Compromise But Neurologically Intact Case

Abstract

The low lumbar spine is deeply located in flexible segments, and has a physiologic lordosis. Therefore, burst fractures of the low lumbar spine are uncommon injuries. The treatment for such injuries may either be conservative or surgical management according to canal compromise and the neurological status. However, there are no general guidelines or consensus for the treatment of low lumbar burst fractures especially in neurologically intact cases with severe canal compromise. We report a patient with a burst fracture of the fourth lumbar vertebra, who was treated surgically but without fusion because of the neurologically intact status in spite of severe canal compromise of more than 85%. It was possible to preserve motion segments by removal of screws at one year later. We also discuss why bone fusion was not necessary with review of the relevant literature.

Keywords: Burst fracture; Fusion; Low lumbar spine.

Fig. 1

A 16-year-old male patient fell down and sustained unstable L4 bursting fracture. Preoperative computed tomography scans demonstrate about 85% canal encroachment and spinous process fracture in spite of neurologically intact status.

Fig. 2

Postoperative simple radiographs show short segment fixation without fusion by posterior approach.

Fig. 3

Computed tomographic scans at 1 year follow-up reveal bone healing and canal remodelling with improved canal compromise.