Unstable L1 burst fracture

Case contributed by Bálint Botz
Diagnosis certain


Fall from height.

Patient Data

Age: 65 years
Gender: Male

The L1 vertebra is wedge-shaped with the anterior outline appearing ill-defined, suggesting acute compression. Retropulsion can also be observed. The involvement of the spinous process is more subtle, yet clearly visible as a broad lucency (see annotated image).


A comminuted burst fracture is visible, which involves all three columns. The retropulsion is compressing the spinal cord while a traumatic left foraminal stenosis can also be discerned. 

Annotated image

Key image showing that spinous process involvement can be detected on the x-ray. 

Case Discussion

This L1 burst fracture is unstable as all three columns are involved.

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