Management of low lumbar fractures by dorsal decompression, fusion, and lumbosacral laminar distraction fixation

Abstract

Object. The authors conducted a study to assess the anatomical appropriateness of using the S-2 dorsal neuroforamina as a hook fixation point, and they present the results of their clinical experience of using a nonscrew alternative for the surgical management of low lumbar (L-4 or L-5) burst fractures. Methods. The technique used involves lumbar laminar fixation, rod contouring (to preserve lordosis), S-1 sublaminar wire fixation, S-2 dorsal neuroforaminal hook fixation, cross-fixation, and distraction. Because the S-2 dorsal neuroforamina was used as a unique fixation point, anatomical data obtained in 10 cadavers supporting the technique's utility are provided. Surgery was performed in six patients by using this technique, and solid fusion was achieved in all. Conclusions. The reestablished lordotic posture was preserved in all but one patient. From an anatomical perspective, the findings corroborate the use of the S-2 dorsal foramina as a hook fixation point.This technique provides a viable adjunct or alternative to sacral screw and ilial fixation techniques.