Although neurologic injury is rarely associated with burst fractures (<4%), some patients with thoracolumbar or lumbar burst fractures sustain cauda equina syndrome. This syndrome is typically characterized by decreased anal tone, perianal hypoesthesia, bowel and bladder dysfunction, decreased or absent reflexes in the lower extremity, and decreased lower extremity muscle strength. The approach and timing of surgical management of such a patient are controversial. Advocated approaches range from posterior decompression with spinal arthrodesis to anterior vertebral corpectomy and arthrodesis. Recommended timing ranges from immediate to delayed. This article characterizes these controversies and summarizes the results in the literature.
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