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Outcomes After Operative Management of Combat-Related Low Lumbar Burst Fractures

Formby, Peter M. MD*; Wagner, Scott C. MD*; Pisano, Alfred J. MD*; Van Blarcum, Gregory S. MD*; Kang, Daniel G. MD; Lehman, Ronald A. Jr MD

doi: 10.1097/BRS.0000000000001006
Outcomes
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Study Design. Retrospective review.

Objective. Report the 2-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% of 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 members.

Methods. 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. Twenty-four 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 neurological injury, 4 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 4 patients (17%). Fourteen (61%) patients had at least 1 postoperative complication, with 7 (30%) requiring reoperation. Five patients had a postoperative wound infection. Five patients had deep venous thromboses, 3 had pulmonary emboli. Mean clinical follow-up was 3.3± 2.2 years. At latest follow-up, all were separated from military service, 10 experienced persistent bowel/bladder dysfunction, 15 had lower extremity motor deficits, and 10 had documented persistent low back pain. Nineteen had chronic pain with 18 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 3 years of follow-up, most of these patients had persistent neurological symptoms and chronic pain.

Level of Evidence: 4

Low lumbar burst fractures are rare injuries occurring with increased frequency in combat casualties. We found a high rate of acute postoperative complications (61%), as well as a high reoperation rate (30%). At approximately 3 years of follow-up, most of these patients had persistent neurological symptoms and chronic pain.

*Department of Orthopaedics, Walter Reed National Military Medical Center, Bethesda, MD

Department of Orthopaedic Surgery, Madigan Army Medical Center, Tacoma WA; and

Department of Orthopaedic Surgery, The Spine Hospital, Columbia University Medical Center, New York Presbyterian, New York, NY.

Address correspondence and reprint requests to Ronald A. Lehman Jr, MD, Department of Orthopaedic Surgery, The Spine Hospital, Columbia University Medical Center, New York Presbyterian, 5141 Broadway, New York, NY 10034; E-mail: ronaldalehman@yahoo.com

Acknowledgment date: January 7, 2015. Revision date: April 5, 2015. Acceptance date: May 22, 2015.

The manuscript submitted does not contain information about medical device(s)/drug(s).

No funds were received in support of this work.

Relevant financial activities outside the submitted work: consultancy, grants, payment for lectures, travel/accommodations/meeting expenses.

The views expressed in this manuscript are those of the authors and do not reflect the official policy of the Department of Army, Department of Defense, or U.S. Government. Three authors are employees of the United States government. This work was prepared as part of their official duties and as such, there is no copyright to be transferred.

Copyright © 2015 Wolters Kluwer Health, Inc. All rights reserved.