J Korean Soc Spine Surg.  2018 Mar;25(1):9-17. 10.4184/jkss.2018.25.1.9.

Treatment of Multiple Thoracolumbar and Lumbar Spine Fractures: Comparison of Contiguous and Non-Contiguous Fractures in Non-Osteoporotic Patients

• Park YG
• Kang SW
• Sohn HM

• KMID: 2408302
• DOI: http://doi.org/10.4184/jkss.2018.25.1.9

Abstract

STUDY DESIGN: Retrospective study.
OBJECTIVES
To evaluate the outcomes of multiple thoracolumbar and lumbar fractures depending on whether the fractures were contiguous. SUMMARY OF THE LITERATURE REVIEW: The treatment of multiple spine fractures in patients without osteoporosis has rarely been reported.
MATERIALS AND METHODS
From February 2004 to January 2016, 81 patients without osteoporosis who had acute thoracolumbar and lumbar fractures and underwent posterior fusion surgery were evaluated. Patients were divided into 2 groups (group A: contiguous, group B: non-contiguous). We investigated the causes of the injuries, the locations of the injuries within the spine, the range of fusion levels, and functional outcomes based on the patients' general characteristics.
RESULTS
Group A comprised 37 patients and group B comprised 44 patients. In most patients, the fusion included 3 segments (group A: 12, group B: 14) or 4 segments (group A: 9, group B: 10). Group A scored 21.2 and group B scored 19.0 on the Korean Oswestry Disability Index. In both groups, longer fusion was associated with poorer clinical results. In the clinical evaluation of the fusion rate, there was no statistically significant difference between the 2 groups (p=0.446).
CONCLUSIONS
In this study, patients with multiple vertebral fractures showed more fusion segments and poor clinical outcomes in contiguous fractures. In the patients with non-contiguous fractures, the clinical results were better when a minimal number of segments was fused. Therefore, the authors recommend conservative treatment to minimize the number of segments that are fused in non-contiguous multiple thoracolumbar and lumbar fractures when decompression is not necessary.

Keyword

Thoracolumbar fractures; Lumbar fractures; Contiguous; Non-contiguous

MeSH Terms

Decompression
Humans
Osteoporosis
Retrospective Studies
Spine*

Figure

• 

  Fig. 1. A 49-year-old woman with contiguous L1-2 fractures after a traffic accident. (A) Anteroposterior and lateral views of the lumbar spine at the time of the injury show decreased L1 and L2 body height and widening of the interspinous space. (B) Three-segment (T12-L3) posterolateral fusion was performed with good restoration of body height and lordosis. She showed excellent clinical results.

• 

  Fig. 2. An 18-year-old man with non-contiguous lumbar fractures. He had depressive disorder and fell from the 10th floor. The physical exam at the emergency department showed motor grade III and sensory abnormality below the right knee. (A) Anteroposterior and lateral views of the lumbar spine at the time of the injury show decreased L2 and L5 body height and widening of the interspinous space. (B) Lumbar spine computed tomography shows burst fractures at both the L2 and L5 vertebrae with severe canal compromise. (C) Posterolateral fusion and posterior decompression were performed only for the L2 burst fractures that caused neurological symptoms. An attempt was made to perform neurological decompression and internal fixation using an anterior approach with a secondary operation, but progression of the neurological symptoms was not observed and we decided to perform conservative treatment. (D) Four years after the operation, good range of motion was observed and almost normal walking was possible.

• 

  Fig. 3. A 32-year-old woman with non-contiguous lumbar fractures. She fell from the sixth floor and the physical exam at the emergency department showed motor grade II below the L2 level and a tingling sensation in both lower limbs. (A) A lumbar spine X-ray shows fractures on the L2 and L4 vertebral bodies. (B) Lumbar spine computed tomography shows severe canal compromise at both L2 and L4. (C) Posterolateral fusion of L1-L5 with posterior decompression of both L1-2 and L3-4 was performed. (D) Five years after the operation, she could walk with a limping gait and some back discomfort. The implants were removed because of loosening.

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