Treatment Tactics for Patients with Isolated Injuries of the Fifth Lumbar Vertebra

Likhachev S.V., Zaretskov V.V., Arsenievich V.B., Ostrovskij V.V., Shchanitsyn I.N., Shulga A.E., Bazhanov S.P.

Key words: traumatic injury of the lumbosacral transition; L₅ vertebra fractures; transpedicular fixation; anterior column support.

2021, volume 13, issue 5, page 31.

DOI: https://doi.org/10.17691/stm2021.13.5.04

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The major management technique for lumbar burst fractures is transpedicular fixation (TPF). However, in relation to fractures of the L₅ vertebra, this tactic often has no advantages over conservative treatment, and, therefore, it is expected to be supplemented with anterior decompression and reconstruction of the anterior column of the L₅ vertebra.

The aim of the study was to determine the most optimal treatment tactics for patients with isolated burst fractures of the fifth lumbar vertebra.

Materials and Methods. We performed a retrospective study of 58 patients treated for isolated burst L₅ fractures. 12 patients refused to undergo surgery and received conservative outpatient treatment. TPF was performed in 27 patients; circular spondylosynthesis (TPF + anterior column support with a Mesh implant) — in 19 patients. The effectiveness of the treatment was assessed by clinical and introscopic research methods.

Results. The radiological and functional outcomes of surgery with conventional TPF for isolated L₅ burst fractures are generally comparable with the outcomes of conservative treatment. In 26% of the patients, the instability of the metal construction developed within 12 months after surgical intervention. Supplementing the transpedicular system with wedging anterior column support with a Mesh implant ensures preservation in 21%, and improves the parameters of the sagittal profile of the lumbosacral transition in 79% of cases.

Meyer M., Noudel R., Farah K., Graillon T., Prost S., Blondel B., Fuentes S. Isolated unstable burst fractures of the fifth lumbar vertebra: functional and radiological outcome after posterior stabilization with reconstruction of the anterior column: about 6 cases and literature review. Orthop Traumatol Surg Res 2020; 106(6): 1215–1220, https://doi.org/10.1016/j.otsr.2020.03.014.
Finn C.A., Stauffer E.S. Burst fracture of the fifth lumbar vertebra. J Bone Joint Surg Am 1992; 74(3): 398–403.
Magerl F., Aebi M., Gertzbein S.D., Harms J., Nazarian S. A comprehensive classification of thoracic and lumbar injuries. Eur Spine J 1994; 3(4): 184–201, https://doi.org/10.1007/bf02221591.
Butler J.S., Fitzpatrick P., Ni Mhaolain A.M., Synnott K., O’Byrne J.M. The management and functional outcome of isolated burst fractures of the fifth lumbar vertebra. Spine (Phila Pa 1976) 2007; 32(4): 443–447, https://doi.org/10.1097/01.brs.0000255076.45825.1e.
Kaminski A., Müller E.J., Muhr G. Burst fracture of the fifth lumbar vertebra: results of posterior internal fixation and transpedicular bone grafting. Eur Spine J 2002; 11(5): 435–440, https://doi.org/10.1007/s00586-002-0390-1.
Seybold E.A., Sweeney C.A., Fredrickson B.E., Warhold L.G., Bernini P.M. Functional outcome of low lumbar burst fractures. A multicenter review of operative andnonoperative treatment of L3–L5. Spine (Phila Pa 1976) 1999; 24(20): 2154–2161, https://doi.org/10.1097/00007632-199910150-00016.
Donnik A.M., Kirillova I.V., Kossovich L.Yu., Zaretskov V.V., Likhachev S.V., Norkin I.A. Biomechanical modeling of reconstructive intervention on the thoracolumbar transition. AIP Conference Proceedings 2018; 1959(1): 90–102, https://doi.org/10.1063/1.5034741.
Blanco J.F., De Pedro J.A., Hernández P.J., Paniagua J.C., Framiñán A. Conservative management of burst fractures of the fifth lumbar vertebra. J Spinal Disord Tech 2005; 18(3): 229–231.
Andreychik D.A., Alander D.H., Senica K.M., Stauffer E.S. Burst fractures of the second through fifth lumbar vertebrae. Clinical and radiographic results. J Bone Joint Surg Am 1996; 78(8): 1156–1166, https://doi.org/10.2106/00004623-199608000-00005.
Zeng H., Wang H., Xu H., Chi Y., Mao F., Wang X. Complete L5 burst fracture treated by 270-degree decompression and reconstruction using titanium mesh cage via a single posterior vertebrectomy. Chin J Traumatol 2014; 17(5): 307–310.
Kocis J., Wendsche P., Visna P. Complete burst fracture of the fifth lumbar vertebra treated by posterior surgery using expandable cage. Acta Neurochir (Wien) 2008; 150(12): 1301–1305, https://doi.org/10.1007/s00701-008-0149-5.
D’Aquino D., Tarawneh A.M., Hilis A., Palliyil N., Deogaonkar K., Quraishi N.A. Surgical approaches to L5 corpectomy: a systematic review. Eur Spine J 2020; 29(12): 3074–3079, https://doi.org/10.1007/s00586-020-06617-y.
Kaner T., Oktenoglu T., Sasani M., Ozer A.F. L5 vertebrectomy for the surgical treatment of tumoral and traumatic lesions of L5 vertebra. Orthop Rev (Pavia) 2012; 4(1): e10, https://doi.org/10.4081/or.2012.e10.
Vazan M., Ryang Y.M., Gerhardt J., Zibold F., Janssen I., Ringel F., Gempt J., Meyer B. L5 corpectomy — the lumbosacral segmental geometry and clinical outcome — a consecutive series of 14 patients and review of the literature. Acta Neurochir (Wien) 2017; 159(6): 1147–1152, https://doi.org/10.1007/s00701-017-3084-5.
Hashimoto T., Kaneda K., Abumi K. Relationship between traumatic spinal canal stenosis and neurologic deficits in thoracolumbar burst fractures. Spine (Phila Pa 1976) 1988; 13(11): 1268–1272, https://doi.org/10.1097/00007632-198811000-00011.
Mick C.A., Carl A., Sachs B., Hresko M.T., Pfeifer B.A. Burst fractures of the fifth lumbar vertebra. Spine (Phila Pa 1976) 1993; 18(13): 1878–1884, https://doi.org/10.1097/00007632-199310000-00026.
Boerger T.O., Limb D., Dickson R.A. Does ‘canal clearance’ affect neurological outcome after thoracolumbar burst fractures? J Bone Joint Surg Br 2000; 82(5): 629–635, https://doi.org/10.1302/0301-620x.82b5.11321.
Likhachev S.V., Zaretskov V.V., Shulga A.E., Gramma S.A., Shchanitsyn I.N., Bazhanov S.P., Zaretskov A.V., Donnik A.M. Injuries to the thoracolumbar junction: bibliometric analysis of English-language literature. Hirurgia pozvonocnika 2018; 15(4): 52–69, https://doi.org/10.14531/2018.4.52-69.
Donnik A.M., Ivanov D.V., Kossovich L.Yu., Levchenko K.K., Kireev S.I., Morozov K.M., Ostrovsky N.V., Zaretskov V.V., Likhachev S.V. Creation of three-dimensional solid-state models of a spine with transpedicular fixation using a specialized software. Izvestia Saratovskogo universiteta. Novaa seria. Seria Matematika. Mehanika. Informatika 2019; 19(4): 424–438, https://doi.org/10.18500/1816-9791-2019-19-4-424-438.
Likhachev S.V., Arsenievich V.B., Ostrovskiy V.V., Shulga A.E., Zaretskov A.V., Ivanov D.V., Dol A.V., Donnik A.M., Zaretskov V.V. Optimization of spondylosynthesis for certain thoracolumbar burst fractures. Sovremennye tehnologii v medicine 2020; 12(4): 30–39, https://doi.org/10.17691/stm2020.12.4.04.
Oprel P.P., Tuinebreijer W.E., Patka P., den Hartog D. Combined anterior-posterior surgery versus posterior surgery for thoracolumbar burst fractures: a systematic review of the literature. Open Orthop J 2010; 4: 93–100, https://doi.org/10.2174/1874325001004010093.
Abdel M.P., Bodemer W.S., Anderson P.A. Spine thoracolumbar sagittal spine alignment: comparing computerized tomography and plain radiographs. Spine (Phila Pa 1976) 2012; 37(4): 340–345, https://doi.org/10.1097/brs.0b013e31821946d1.
Melgar M.A., Tobler W.D., Ernst R.J., Raley T.J., Anand N., Miller L.E., Nasca R.J. Segmental and global lordosis changes with two-level axial lumbar interbody fusion and posterior instrumentation. Int J Spine Surg 2014; 8: 10, https://doi.org/10.14444/1010.

Likhachev S.V., Zaretskov V.V., Arsenievich V.B., Ostrovskij V.V., Shchanitsyn I.N., Shulga A.E., Bazhanov S.P. Treatment Tactics for Patients with Isolated Injuries of the Fifth Lumbar Vertebra. Sovremennye tehnologii v medicine 2021; 13(5): 31, https://doi.org/10.17691/stm2021.13.5.04