Minimal invasive nonfusion technique for the treatment of noncontiguous lumbar burst fractures in young age patient: A case report

Abstract

Rationale: In the treatment of noncontiguous lumbar burst fractures, there still remains controversy over proper surgical procedures.

Patient concerns: A 19-year-old female patient visited our hospital after fall down from 3 m high.

Diagnoses: Initial neurologic examination revealed an incomplete spinal cord injury characterized by hypoesthesia and motor grade of 2 below the L2 segment. Lumbar computed tomography and magnetic resonance imaging demonstrated L2 and L5 burst fractures severely obliterating the spinal canal.

Interventions: She underwent emergent PSSPSF at L1-2-3 and L4-5-S1 following bilateral L1 and L4 laminotomy with reduction of bony fragments by tapping method.

Outcomes: She was gradually recovered and able to walk with assistance two weeks after surgery. Removal of implants was performed at 12 months after surgery. Follow-up radiography showed well-preserved segmental motion and adequate decompressed spinal canal with fused fractured bony fragment. She returned to her normal daily activities without any neurologic deficits and pain.

Lessons: Noncontiguous burst fracture of the lumbar spine is an unusual injury. For the adequate management in patient with neurologic deficit, reduction of the fractured body and stabilization of vertebral column is necessary. It is also important to preserve the segmental motion in young age patients. From that point of view, temporary PSSPSF with spinal canal decompression is considered as minimal invasive surgery with significant low morbidity, providing stability with motion saving and good clinical outcome.

Figure 1

Preoperative radiologic analysis. (A) The Cobb angle of L2 and L5 was formed between white lines were 3.8° and −32.8°, respectively. The vertebral body compression calculated by the formula being [1−(2b/a + c)] × 100. Calculation results were 40% at L2 and 50% at L5. (B) The preoperative sagittal CT scan showed severe obliteration of the spinal canal. (C) Preoperative MRI scan demonstrated traumatic disc injury at L1-2 and acute burst fractures at L2 and L5. Before surgery, canal compromise of L2 (C) and L5 (D) was 70% and 50%, respectively. CT = computed tomography, MRI = magnetic resonance imaging.

Figure 2

(A) In the postoperative radiography, the two red circles indicate the area of laminotomy. (B) The illustration described tapping and reduction technique of the bony fragments severely compromising the spinal canal. Postoperative 12 months follow-up CT scans showed well-fused fractured bony fragments and canal compromise was reduced from 70% to 28% at L2 (C) and 50% to 30% at L5 (D). CT = computed tomography.

Figure 3

Change of Cobb angle in serial lateral radiographs. (A) Before surgery, the Cobb angle of L2 was 3.8° and that of L5 was −32.8° (B) After immediate surgery, the angle was reduced to −7.5° and −36.1° (C) At 12 months after surgery, the angle changed to 6.1° and −15.6° (D) At 24 months after surgery, the angle increased to 13.3° and −15.5°.