Diagnosis and Management of Low Lumbar Burst Fractures

Fractures of the low lumbar spine are relatively uncommon and have various injury patterns. Treatment must be individualized and should take into account the fracture type, ligamentous injury pattern, neurological injury, the limitations of surgical implants, and the anatomical approaches available. Nonoperative management of burst fractures for patients without neurological deficits has generally been reported to have acceptable outcomes. For low lumbar burst fractures or fracture dislocations of the lumbosacral segment where neurological injury has occurred, surgery is indicated. This surgery should include decompression (posterior or anterior), spinal realignment with maintenance of lumbar lordosis, and instrumentation over minimal segments. Conservatively managed patients require continued follow-up to manage symptoms and check for possible development of deformity.