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Fractures of the lumbar spine

Most of the approximately six thousand serious injuries of the spine in Germany per year related to the portion of the thoracic and lumbar spine. Traffic and work accidents and risky sports and motorcycling are the main causes. While minor injuries conservatively, that is be treated without surgery, complex spinal injuries often lead to an unstable situation in which each strain and rotation or displacement of the spine may lead to nerve or spinal cord injury. About 20% of people affected by a severe spinal injury suffered while an incomplete to complete paralysis.

Classification of Fractures
According to the Magerl fractures are classified into three types.
When A - fracture (compression fractures, ie fractures pinch), the rear structure of the intact spine, it is the front pillar, ie the affected vertebral body. Differences are stable A 1 - fractures (cover plate impression) to very unstable A 3 - Fractures (Burst fractures), where pieces of bone can slip into the spinal canal and squeezing the spinal cord. The intact posterior portions of the spine protect against hyperextension.
For B - fractures (Distraktion fractures, overstretching fractures) there is a partial or complete loss of ligament stability and fractures in the vertebral joints. There are mainly the rear, that is dorsal structures affected. Lateral displacements are possible, as the direct lumbar disc injury.
The C - fractures (twisting fractures ) Vertebral fractures are the most dangerous, because they have the highest instability. These fractures have not only the rupture of the posterior ligaments and the anterior vertebral body fracture (combination of A and B), a rotational component.

Different fracture types

Diagnostics
In the clinical examination reveals a sharp pain at the site of vertebral fracture. Some can be proved bruising. In the neurological examination, any damage to the spinal cord or the nerve to be assessed. Fractures in the cervical and thoracic spine may result in paraplegia. The X-ray examination of the spine is a diagnostic assessment. Here often show strong evidence for Wirbelköperzerreissung or destruction .
Further investigation procedure, the computed tomography ( CT) and magnetic resonance imaging ( MRI). Computed tomography shows details of the fracture suffered and it can be a 3D representation. Any investments in MRI of the spinal discs and spinal cord can be detected or ruled out.

Treatment
The treatment goal is thus the fastest possible restoration of stability, strength and shape of the spine. In a spinal cord compression by a fracture fragment , as can happen with Berstungsbrüchen , the discharge of the spinal cord is superficial. With advances in spinal surgery and severe injury with a low risk and can often be corrected with minimally invasive and stabilized. In this case, stabilization systems ( screws and rods ) were used to again align the spine and fastened. It is also an erection and support of the anterior column (ie the broken vertebra). Often, especially in A.1.3 fractures, an injection of bone cement is sufficient. similar to kyphoplasty for osteoporotic fractures. However, there is another cement used is biologically converted into bone. In complex fractures involving the intervertebral discs of the vertebrae must be removed and replace with an implant often. In this case, a side plate is attached to prevent rotation.

 

Lumbar spine fractures