Case Study: Burst Fracture 2
- The patient is a 47-year-old male construction worker who fell from a ladder and was unable to stand up or walk after the fall.
- He had severe weakness of both legs (quads 2/5, feet dorsiflexion 3+/5) and numbness.
Sagittal and axial CT sections showing L3 burst fracture with coronal split and with severe retropulsion into the spinal canal causing stenosis
Sagittal and axial MRI sections showing L3 burst fracture with fracture retropulsion causing severe canal stenosis and displacement of the thecal sac (nerve roots)
- L3 burst fracture with canal retropulsion causing severe lumbar spinal stenosis
- MIS (minimally invasive surgery) lateral corpectomy, placement of expandable cage and percutaneous screws placed between muscle planes
- 3 hours of operative time
- 120 cc blood loss
Intraoperative X-ray AP image showing docking of the expandable tubular retractor at the fracture site for corpectomy and canal decompression. This retractor is placed by splitting the fibers of the iliopsoas (or hip flexor muscle), therefore preserving muscle function.
AP X-ray image showing placement of the cage after corpectomy and expansion of the cage with spinal column height restoration.
AP and lateral Xray images showing a cage with restoration of vertebral body height and placement of percutaneous pedicle screws in between muscle planes. These screws are placed from a lateral position, preventing the need to flip the patient during surgery, decreasing complications and surgical time.
- The patient recovered full leg strength after surgery.
- He returned to work without any restrictions six months after surgery.
- In a patient with his characteristics,(young heavy laborer), MIS surgery preserved his back muscles and minimized the fusion levels, allowing him to return to his prior employment without any restrictions.
Saint Barnabas Medical Center
Formerly St. Luke’s-Roosevelt
Hospital in Manhattan
Formerly Lenox Hill Hospital