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

Abstract

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.