Spine Injury: Lumbar

Basics

Description

  • Major spinal injuries:
    • Wedge compression:
      • Involves anterior half of the vertebra
      • If <50% anterior compression of the vertebral body, injury considered stable
      • No ligamentous injury
      • No neurologic deficit
    • Burst fracture:
      • Involvement of the entire body under axial load
      • Vertebral body fracture may be displaced posteriorly into the neural canal
      • Kyphosis may be seen on lateral radiograph
      • Posterior ligamentous injury
      • Associated pelvic, lower extremities, and calcaneal fractures
      • Possible neurologic deficit
    • Chance fracture (seat belt injury):
      • Abdominal injuries commonly associated
      • Type I is a pure bony injury; fracture line through spinous process, pedicles, and vertebral body
      • No kyphosis evident on lateral radiograph
      • Often no neurologic deficit
    • Fracture dislocations:
      • Anterior, posterior, or lateral translation of superior vertebral segment over the inferior segment
      • Mostly soft tissue injury; no fracture
      • Complete disruption of posterior ligaments and intervertebral disc
      • Neurologic deficit present
  • Simple or minor spinal fractures:
    • Isolated spinous process fracture:
      • Ligamentous disruption
      • No neurologic deficit
    • Isolated transverse process fracture:
      • Ligamentous disruption
      • Neurologic deficit possible; rare isolated root injury
    • Articular process fracture:
      • No neurologic deficit
      • May be instable if multiple or displaced

Etiology

  • Motor vehicle accidents (MVA)
  • Fall from height landing on the feet (associated calcaneal fractures) or on the buttocks
  • Blunt trauma with axial distraction, axial compression, or translational forces applied to lumbar region
  • Penetrating injury: primary gunshot wound
  • Sport related injury

Pediatric Considerations

  • Rare reports of child abuse presenting as lower extremity flaccid paralysis owing to lumbar spine fracture
  • Spinal cord terminates at L3 in newborn and recedes to L1 by adulthood; direct cord damage possible in children with high lumbar fractures
  • End plate avulsion fractures: Adolescent injury usually at L4–L5 or L5–S1 level; ligament pulls off vertebral body end plate; associated neurologic findings

There's more to see -- the rest of this topic is available only to subscribers.