Burst fracture

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Burst fractures are major thoracolumbar spine fractures due to pure axial load compression injury causing failure of the middle and anterior columns. This includes the anterior half of the vertebral body/disc and the ALL (anterior column) as well as the posterior body/disc and the PLL (middle column). Most fractures occur at the thoracolumbar junction. Neurologic deficit occurs in approximately half of cases. Burst fractures are divided into five subtypes:

1. superior endplate (commonest), from axial load plus flexion at TL junction

2. superior and inferior endplates, from axial load plus extension at lower lumbar segment

3. rotation, from axial load plus rotation usually at midlumbar segment

4. lateral flexion

5. inferior endplate (rare)

Evaluation and managementPlain films will demonstrate posterior vertebral body fracture with reduced height and dislocation into the spinal canal on lateral view and increased interpediculate distance from middle column failure on AP. CT findings are similar. Burst fractures involve neurological and possibly mechanical instability. Therefore, patients must not ambulate directly following injury to minimize axial load. Combined instability requires surgical decompression and fusion, often anteriorly and posteriorly. Mild isolated neurological instability may be treated with TLSO brace.

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