Isolated Lumbar 4 Burst Fracture with Neurological Deficits: A Rare Case Treated with Posterior Lumbar 3-5 Fixation and Lumbar 4 Laminectomy

Due to the unique biomechanics of the lower vertebrae, which are protected by the iliolumbar ligaments, pelvis, and strong musculature, high-energy trauma rarely results in an isolated burst fracture of the fourth lumbar vertebra (L4). Moreover, an isolated L4 burst fracture causing neurological deficits is even rarer. Rarity of these fractures resulted in limited studies on treatment approaches and lack of treatment guidelines. In this case report, we discuss the surgical approach involving posterior L3- L5 fixation and L4 laminectomy, as well as its contribution to the patient's neurological recovery. A young adolescent male involved in a high energy vehicle accident was admitted to our clinic. The patient, who had an active lifestyle and no history of bone or spinal malformation, presented with neurological deficits in both lower extremities, as well as bladder and anal sphincter dysfunction. Due to the severity of the neurological deficits, surgical intervention was deemed necessary. Posterior fixation of L3-L5 and laminectomy of L4 were performed. The patient underwent an extensive fourmonth rehabilitation program with an appropriate diet programme. Postoperative progress was monitored from the time of the accident until four months after surgery. The patient was discharged four months after admission.