Acute L1 burst compression fracture

Case contributed by Dr Henry Knipe

Presentation

Fall from more than 2 meters. Impact onto coccyx. Lumbar pain.

Patient Data

Age: 40 years
Gender: Male

A compression fracture of L1 is noted with approximately 30% loss of height anteriorly. Mild narrowing of the central canal at this level.

Targeted T12-L2 examination

CT

Burst compression fracture of the L1 vertebral body is associated with a 35% loss of vertebral body height. The fracture line breaches both the anterior and posterior vertebral body cortex and the anterior superior endplate. There is a 3 mm retropulsion into the spinal canal, resulting in only mild canal narrowing. The alignment is otherwise intact. No other fracture detected. The paraspinal soft tissues are unremarkable.

Conclusion:

L1 burst fracture representing a two-column injury.

Case Discussion

  • most often the result of axial loading in high-energy trauma (e.g. fall from height, motor vehicle collision)
  • burst fractures are a subtype of compression/crush fractures
  • retropulsion of bone fragments can result in central canal stenosis, nerve root or spinal cord injury, or vascular injury

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