Treatment strategies in injuries to the lumbar spine

This paper deals with the specific indications for different treatments in cases of spinal fractures in the lumbar segment and with the techniques applied in current operative procedures. We present a concept of treatment that is based on the biomechanics of the spine and the results of a comparative study of conservative and operative treatments. The technical implementation of simultaneous dorsal-ventral procedures on the lumbar spine with the patient in lying prone are explained. Relatively few problems involving loss of correction are encountered in the lumbar spine. On balance, loss of correction occurs less frequently after a conservative therapy than after invasive interventions. We recommend noninvasive-therapy for type A1.2 vertebral fractures with kyphotic deformation by < 20 degrees. In the case of unstable fractures and type A fractures associated with kyphotic deformations by > 20 degrees we prefer to apply a minimally invasive technique and use a ventral approach.