The management of burst fractures of the fifth lumbar vertebra.

Burst fractures of the fifth lumbar vertebra are extremely rare. Three cases of this fracture are reported and the treatment discussed. Two patients were treated conservatively with bed rest and lumbar bracing; the third underwent posterior decompression and instrumentation. All patients showed a loss of lordosis between L4 and the sacrum, this being greatest in the surgically treated patient. It is suggested that current instrumentation cannot adequately maintain this unusual fracture in good alignment and a conservative approach is advocated.