Burstsfraktur

Burstsfraktur (burst fracture) is a type of vertebral fracture produced by an axial load that drives the vertebral body to break into multiple fragments, some of which may be retropulsed into the spinal canal. The injury disrupts the anterior and middle columns and can be unstable, risking deformity and neurologic compromise. It most commonly occurs at the thoracolumbar junction (roughly T12 to L2) after high-energy trauma such as falls from height, motor vehicle collisions, or crush injuries.

Clinical features include sudden severe back pain and point tenderness; neurological signs such as numbness, weakness, or gait disturbance occur if fragments compress the spinal canal or nerve roots. Severe canal compromise may necessitate urgent decompression.

Diagnosis relies on imaging. Plain radiographs may show vertebral height loss and a widened or stepped vertebral body; computed tomography delineates the fracture pattern and retropulsed fragments more clearly; magnetic resonance imaging assesses canal compromise, disc and ligament injury, and neural element involvement. Classification systems include the AO Spine Thoracolumbar Injury Classification System and the Thoracolumbar Injury Classification System (TLICS), which help define stability and guide treatment.

Management is tailored to stability and neurologic status. Stable, neurologically intact bursts fractures may be treated nonoperatively with immobilization and analgesia, though bracing is common. Unstable fractures, significant canal compromise, or neurologic deficits often require surgical stabilization—most often posterior pedicle screw instrumentation with fusion; anterior reconstruction can be considered in selected cases. Early stabilization improves outcomes; prognosis varies with canal compromise and deformity risk but many patients recover with appropriate treatment.