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Burst fracture of vertebra — Clinical Guidelines

Overview

Burst fractures involve a sudden collapse of the vertebral body, often leading to spinal canal compromise and potential neurological deficits due to impaction of bone fragments into the spinal canal. 1

Diagnosis

Clinical Presentation: Neurological deficits, back pain, and spinal deformity.

Imaging: CT is essential for detailed assessment of vertebral body collapse and spinal canal involvement. MRI helps evaluate soft tissue damage and disc degeneration. 2 3

Grading: AO classification system categorizes thoracolumbar burst fractures into types A, B, and C based on the extent of vertebral body disruption and spinal canal involvement. 1

Management

First-Line Treatment: Short-segment pedicle screw fixation without fusion to stabilize the spine and allow motion preservation. 3 4

Adjunctive Procedures:

- Indirect Reduction: Utilized to realign the fractured vertebra without direct manipulation. 1 - Hydroxyapatite Cement Injection: Reinforces the fractured vertebral body, enhancing stability post-fracture. 4

Neurological Deficit Management: Early surgical intervention within 4 days of injury for patients with neurological deficits to optimize recovery. 3

Special Populations

Elderly: Short-segment fixation without fusion appears effective in preserving motion and reducing post-traumatic disc degeneration, though long-term outcomes should be monitored closely. 3

Comorbidities: No specific recommendations provided in the abstracts; individualized treatment plans considering overall health status are advised.

Key Recommendations

Use Short-Segment Pedicle Screw Fixation Without Fusion for unstable thoracolumbar burst fractures to preserve spinal motion and potentially avoid post-traumatic disc degeneration. (Evidence: Moderate 3 4)

Consider Hydroxyapatite Cement Injection for vertebral body reinforcement in unstable burst fractures to enhance stability post-operatively. (Evidence: Weak 4)

Early Surgical Intervention within 4 days for patients with neurological deficits to improve neurological outcomes. (Evidence: Moderate 3)

References

1 Song Y, Pang X, Zhu F. Finite element analysis of the indirect reduction of posterior pedicle screw fixation for a thoracolumbar burst fracture. Medicine 2022. link 2 Wang J, Zhou Y, Zhang ZF, Li CQ, Zheng WJ, Liu J. Radiological study on disc degeneration of thoracolumbar burst fractures treated by percutaneous pedicle screw fixation. European spine journal : official publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society 2013. link 3 Toyone T, Ozawa T, Inada K, Shirahata T, Shiboi R, Watanabe A et al.. Short-segment fixation without fusion for thoracolumbar burst fractures with neurological deficit can preserve thoracolumbar motion without resulting in post-traumatic disc degeneration: a 10-year follow-up study. Spine 2013. link 4 Christodoulou A, Ploumis A, Terzidis I, Pournaras I. Vertebral body reconstruction with injectable hydroxyapatite cement for the management of unstable thoracolumbar burst fractures: a preliminary report. Acta orthopaedica Belgica 2005. link

Burst fracture of vertebra