Lumbosacral fracture

see also Lumbosacral fracture dislocation.

A fracture of the lumbosacral spine involves a break in one or more bones of the lumbar and sacral regions of the spine (vertebrae L1 through L5 and S1 through S5) in the lower back (lumbosacral spine).

Fractures in the lumbosacral spine may be classified according to the mechanism of injury and the degree of instability.

Categories of fractures include compression fracture, transverse process fracture, burst fracture, flexion-rotation injury, and pathologic fracture. The fracture may be classified further as stable or unstable. A stable fracture is one that is not likely to change as the weight-bearing load on the spine changes, which makes it less likely to result in nerve or spinal cord damage (e.g., neurologic deficit or paralysis). Unstable fractures are described by abnormal motion at the fracture site and may be associated with neurologic injury. Fracture of vertebrae in the lumbosacral area can result in either temporary or permanent disability. The majority of lumbosacral fractures occur without spinal cord injury: 10% to 38% of adults with fractures in the lumbosacral region are reported to have associated spinal cord injury (Vinas 2008).

Lumbosacral fractures can involve any lumbar vertebrae but often involve the lumbosacral junction (L5-S1), where the two sections of spine articulate. Nerve compression with neurologic deficit may or may not occur with these injuries. Instability is common, especially in oblique sacral fractures that can destroy stability on each side of the vertebral junction. Vertical sacral fractures usually occur in conjunction with a fracture in the pelvic ring. Transverse sacral fractures can be either (1) a partial break or bending of the bone (“green-stick” fracture) that may increase the concave curvature (kyphosis) of the lower spine but is usually stable or (2) an unstable proximal transverse fracture more subject to neurologic deficit.

Compression fractures most commonly occur after falls or jumps from a height, with the individual landing on his or her heels. Compression fractures can also occur as the result of a sports injury or motor vehicle accident and are sometimes overlooked because of other, more serious injuries.

Fractures of the transverse process are most often the result of direct violence.

Fractures resulting from forceful flexion and rotation are common in motor vehicle and mining accidents. Fractures caused by acute flexion of the spine are most often sustained in motor vehicle accidents by individuals wearing a lap seatbelt without a shoulder harness (seatbelt injuries).

Pathologic fractures are seen in individuals with osteoporosis or other disease conditions that compromise bone strength. Incidence and Prevalence: Approximately 150,000 people sustain fractures to the vertebral column each year; the majority are in the lumbar spine and occur without spinal cord injury (Vinas 2008; Vinas 2004). Among sports-related injuries, 9% to 15% are estimated to result in spinal injury, of which 3% to 7% involve the lumbar spine (Vinas 2008). The majority of lumbosacral fractures do not involve spinal cord injury; cord injury occurs in about 10% to 38% of adult spine fractures 1).

Vinas, Federico C. “Lumbar Spine Fractures and Dislocations.” eMedicine. Eds. Lee H. Riley, et al. 8 Jul. 2004. Medscape. 13 Oct. 2008 <>.
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