Citation

Formby PM, Wagner SC, Pisano AJ, Van Blarcum GS, Kang DG, Lehman RA. Spine 2015; 40(18): E1019-24.

Affiliation

1Department of Orthopaedics, Walter Reed National Military Medical Center, Bethesda, MD 20889 2Department of Orthopedic Surgery, Washington University, St. Louis, MO 63110.

Copyright

(Copyright © 2015, Lippincott Williams and Wilkins)

DOI

10.1097/BRS.0000000000001006

PMID

26020848

Abstract

STUDY DESIGN: Retrospective reviewOBJECTIVE. Report the two year operative and clinical outcomes of these service members with low lumbar fractures. SUMMARY OF BACKGROUND DATA: The majority of spinal fractures occur at the thoracolumbar level with fractures caudal to L2 accounting for only 1% spine fractures. A previous report from this institution regarding combat-related spine burst fractures documented an increased incidence of low lumbar burst fractures in injured service membersMETHODS. Review of inpatient and outpatient medical records in addition to radiographs for all patients treated at our institution with combat-related burst fractures occurring at the L3-L5 levels.

RESULTS: 24 patients with a mean age of 28.1± 7.2 underwent surgery for low lumbar (L3-L5) burst fractures. The mean number of thoracolumbar levels injured was 2.9±1.4. Eleven patients had neurologic injury, four of which were complete. The mean days to surgery were 16.8± 24.5. The mean number of levels fused was 4.3± 2.1, with fixation extending to the pelvis in four patients (17%). Fourteen (61%) patients had at least one postoperative complication, with seven (30%) requiring reoperation. Five patients had a post-operative wound infection. Five patients had deep venous thromboses, three had pulmonary emboli. Mean clinical follow-up was 3.3± 2.2 years. At latest follow-up, all were separated from military service, ten experienced persistent bowel/bladder dysfunction, fifteen had lower extremity motor deficits, ten had documented persistent low back pain. Nineteen had chronic pain with eighteen patients still taking pain medications and/or muscle relaxers.

CONCLUSION: Low lumbar burst fractures are a rare injury with an increased incidence in combat casualties engaged in the wars in Iraq and Afghanistan. We found a high rate of acute postoperative complications (61%), as well as a high reoperation rate (30%). At approximately three years follow-up, most of these patients had persistent neurological symptoms and chronic pain.

Language: en