Low Lumbar Fractures, a history of unique biomechanics and treatment options: a review article

Acute lower lumbar spinal fractures (L4 and L5) can cause major neurologic damage and mechanical instability. The ultimate surgical method for management of unstable lower lumbar spine fractures remains questionable.

Online search databases including Google Scholar, PubMed and Ovid were searched using these keywords: low lumbar, fractures, spine trauma, biomechanics, classification, anatomy, spinopelvic alignment, non-operative and surgical treatment options. Finally, about 47 related studies were identified and reviewed.

The L4 and L5 vertebra and related discs contribute to 50% of the lordosis in lumbar area. Fracture of the trapezoidal body of fifth vertebra can considerably decrease this and change the L4/5 and L5/S1 biomechanics. Lower lumbar spine, in contrast to the thoracolumbar junction is secure by the pelvis and the robust musculature. There is great controversy about the treatment of lumbar burst fractures without neurologic deficit. The surgical indication and optimal procedure can be influenced by numerous aspects such as the severity of signs and symptoms, the amount of vertebral body height loss and spinal canal involvement, and finally, the continuity of the posterior spinal components.

 There has been great controversy concerning what establishes the paramount treatment for low lumbar burst fractures. Conservative care has been related with respectable outcomes for patient with a burst fracture and neurologic intact. In more severe injuries, decisions contain spinal decompression and stabilization via a posterior or anterior approach based on the surgeon’s preference. For lower lumbar burst fractures or fracture-dislocations of the lumbo–sacral junction with neurologic injury, posterior decompression and stabilization and a period of rest and bracing for preservation lumbar lordosis are appropriate