Lumbar spine compression fracture

Case contributed by Dr Patsy Robertson

Presentation

MVA.

Patient Data

Age: 22
Gender: Female

Trauma CT

Portal venous phase volume acquisition through the abdomen and pelvis has been obtained.

The liver, spleen, adrenal glands, kidneys and pancreas are unremarkable. No traumatic bowel injury identified. No free intra-abdominal fluid or air identified.

Soft tissue stranding is seen in the anterior and lateral pelvic subcutaneous tissues.

CT Thoracic and Lumbar spine:

Reformats of the lumbar spine in both sagittal and coronal as well as axial images have been reviewed.

Fracture through the superior endplate of L2 with minor loss of vertebral body height. No retropulsion of fracture fragments.  Undisplaced fracture extending through the spinous process and left inferior articular facet. No widening of the L1/2 intervertebral disc space. Subtle widening of the L1-2 interspinous space.

Conclusion:

Fracture through the superior endplate of L2 and undisplaced fracture through the spinous process extending into the left inferior articular facet of L1. The pattern of injury is that of a chance-type injury. An MRI could help further evaluate ligamentous injury. 

MRI

Performed 2 weeks following the CT when the patient represented with ongoing pain.

There is loss of normal lumbar lordosis. The vertebral alignment is otherwise normal. 

Superior endplate of L2 vertebral body fracture with minor loss of vertebral height (~ 15%).

Fracture through the spinous process of L1 vertebra. High signal within the interspinous ligaments at the T12-L1, and L1-L2 level shown best on the sagittal STIR images, suggestive of ligamentous injury.

The spinal canal is widely patent; there is no cauda equina compression. There is no evidence of an epidural haematoma. Exit foramina are capacious at all levels.

Case Discussion

Given the morphology of injury is of a compressive fracture, neurology was intact and there was oedema in the interspinous ligaments only, TLICS score would be </= 3. This patient was treated non operatively.

Although the fracture of the spinous process and oedema in the interspinous ligaments suggested a flexion-distraction injury (Chance fracture), there were no fractures of the pedicles and transverse processes. The ligaments were not clearly torn and there was no convincing distraction posteriorly. This injury was thus regarded as stable.

Follow up plain films at 2 months showed no significant change.

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Case information

rID: 30048
Case created: 15th Jul 2014
Last edited: 26th Nov 2015
Inclusion in quiz mode: Included

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