Surgical management and outcomes analysis of lower lumbar (L3-L5) burst fractures: A single-center experience and meta-analysis.

BACKGROUND: Lower lumbar (L3-L5) burst fractures are uncommon injuries with distinct clinical and biomechanical characteristics. We evaluated injury patterns, surgical management, and outcomes in patients treated at a single center and performed a systematic review and meta-analysis to assess neurological and functional outcomes reported in the literature. MATERIALS AND METHODS: We retrospectively reviewed surgically treated L3-L5 burst fractures between January 2015 and July 2022. A Preferred Reporting Items for Systematic Reviews and Meta-analyses-compliant systematic review of studies published from January 1993 to January 2026 was conducted using PubMed, Google Scholar, and the Cochrane Library. RESULTS: Eighteen patients (mean age: 28.1 ± 9.1 years; 77.8% male) were included. Falls from height were the most common mechanism (61.1%), with L4 most frequently involved (61.1%). All fractures were AO Spine Type A (61.1% A3; 38.9% A4); 50% had posterior column injury, and 61.1% had Thoracolumbar Injury Classification and Severity Score ≥5. Preoperatively, 55.5% had neurological deficits and 27.8% had bowel/bladder dysfunction. All underwent posterior spinal instrumentation and fixation; 66.7% received long-segment fixation, 33.3% short-segment fixation, and 27.8% corpectomy with anterior column reconstruction. Surgery significantly improved vertebral body height, sagittal alignment, and canal diameter. At a mean follow-up of 3.8 years, 66.7% achieved ASIA Grade E, with no neurological deterioration. Complications occurred in 11.1% and 94.4% reported minimal disability (Oswestry Disability Index). Meta-analysis of 16 studies (248 patients) demonstrated pooled neurological improvement of 53% (95% confidence interval [CI], 0.25-0.79) and return-to-work (RTW) of 85% (95% CI, 0.76-0.91). CONCLUSION: Surgical treatment produced favorable radiological and functional outcomes, with neurological improvement in 53% of patients and an 85% RTW rate.