Complete burst fracture of the fifth lumbar vertebra treated by posterior surgery using expandable cage.

Abstract

This report characterises a 25 year old male patient with a complete burst fracture of the fifth lumbar vertebra with dislocation. He was treated by posterior surgery with transpedicular instrumentation and an expandable cage from the posterior approach. Burst fractures of the fifth lumbar vertebra are extremely rare. Patients with positive neurological findings should be treated by the posterior approach. This surgery consists of reduction, decompression, transpedicular stabilisation and fusion. The young man in our report was treated by posterior surgery only. It consisted of laminectomy, suture of the thecal sac tear, discectomies and subtotal removal of the fifth lumbar vertebra. Repositioning was carried out simultaneously with support using Synex TM Synthes USA telescopic cage and SOCON TM Aesculap Germany transpedicular fixator. The patient suffered neither wound complications nor instrumentation failure. He is currently able to walk with the help of peroneal bands but without crutches. Treatment of fractures of the fifth lumbar vertebra depends on fracture type and neurological findings. Conservative management of this condition is appropriate provided there is no neurological damage and canal stenosis and deformity is minimal. Surgical treatment of burst lumbar fractures with neurological deficit is strongly recommended. The optimum treatment remains debatable.