Wednesday, December 11, 2024
Unstable Lumbar Burst Fracture
Amber S. Gordon, MD
Neurosurgeon
Mobile Infirmary
& Nurse Practitioner: Brook Van Vaghel
Doctor Gordon went through 4 years of undergrad at Vanderbilt University, graduating with an undergrad in Biomedical Engineering. She then did 4 years med school at the University of Alabama at Birmingham and 6 years of residency there also. She is the only female neurosurgeon in Mobile, Alabama.
On Day 3 of Trauma Week, we focused on our patient, who is now undergoing surgery, and had the privilege of learning from a guest neurosurgeon—one of only 219 female neurosurgeons in the country and the third female to graduate from UAB. We explored spinal fractures, including compression fractures, which are stable and often do not require surgery, and burst fractures, which are unstable and need surgical intervention. Our patient has a burst fracture requiring a complex procedure to remove fragmented bone, replace it with bone and cement to reduce the fracture, stabilize the spine with screws above and below, and connect them with rods. This process acts like an internal cast, and the fusion will take six months to a year to heal.
We also discussed the ASIA grading system for spinal cord injuries, which assesses motor and sensory function. Grades range from A, where there is no motor, sensory, or sacral sparing, to E, where all motor and sensory functions are normal. Intermediate grades (B, C, and D) reflect varying levels of incomplete injury. For example, Grade C indicates that less than 50% of muscles are strong enough to lift arms or legs off the bed, while Grade D shows more than 50% of muscles can perform this task.
Post-surgery, the patient is in a TLSO brace and must follow strict guidelines: no driving, bending, lifting, or twisting. For the first 2–4 weeks, they cannot lift anything heavier than 10 pounds, after which weight limits gradually increase.
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