Lumbar spine fractures are often a result of significant blunt trauma such as motor vehicle accidents or a fall from height. Non-traumatic causes include osteoporotic and pathological fractures.
Traumatic fractures are more common in males. The risk of osteoporotic fractures increases with age and they are more common in females 1.
In traumatic injuries lumbar spine fractures can be associated with:
- pelvic or sacral fractures
- intra-abdominal injuries
- lower rib fractures
- thoracic or cervical spine fractures
- calcaneal fractures
- long bone fractures or dislocations
- diaphragmatic rupture / pneumothorax
In a non-traumatic setting, there are often concomitant fractures 3 and they are often associated with:
The lumbar spine is more mobile than the thoracic spine. The thoracolumbar junction is the most common location of traumatic fractures due to the transition point of increased mobility. Pathological fractures in this region are also more susceptible to instability 2.
- fracture of the vertebral body
- often due to axial loading
- can affect a single endplate or both
- can occur as a coronal split fracture (without the involvement of the posterior wall)
- most common type in osteoporotic and pathological fractures
- comminuted compression fracture through the vertebral body
- result of high energy axial loadings such as a fall from height or motor vehicle accident
- the posterior vertebral wall is involved
- either incomplete or complete, depending on whether only one or both endplates are involved
- monosegmental flexion-distraction injury with compression of the vertebral body and horizontal fracture of the posterior arch and spinous process 6
- the majority occur at the thoracolumbar junction T11-L2 8
- posterior tension band disruption
- flexion-distraction injury with compression of the vertebral body and disruption of the posterior tension band with or without bony involvement of the posterior arch
- typically a result of forced flexion anterior to the abdomen e.g. seatbelt injury
- associated with intra-abdominal injuries
- anterior tension band disruption
- extension injury with disruption of the anterior tension band and intact posterior elements
translation-rotation and/or displacement injuries
- horizontal displacement or rotation of the vertebral bodies with respect to each other
- the result from torsional and shear forces
- can be combined with other vertebral fracture types such as tension band injuries or vertebral body, or process fractures
transverse process fracture
- stable fracture if isolated
- often multiple when present
- can be associated with sacral fractures especially when multiple
- can be associated with translation-rotation or displacement injuries
- vertical spinous process fractures
- if isolated they are considered stable 4-7
- can be associated with osteoporotic compression fractures and in such a case are usually located one level above 12
Treatment and prognosis
Treatment and prognosis of traumatic lumbar fractures depend on the grade and morphology of the injury, the integrity of the posterior ligaments and the vertebral disc 4-7, and the presence of neurological symptoms. It will be surgical most of the time if there are structural displacements or relevant deformity, associated posterior ligamentous or discoligamentous injuries, or concomitant neurological symptoms 7.
Uncomplicated compression fractures with involvement of a single endplate and without relevant kyphotic (>15-20°) or scoliotic deformity (>10°) can be managed conservatively 7.
Osteoporotic vertebral compression fractures can be treated surgically or with vertebral augmentation including kyphoplasty and vertebroplasty 3.
Pathological vertebral fractures are treated with surgery, radiation therapy or kyphoplasty and/or vertebroplasty depending on patient's condition and underlying disease 11.
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