Spine Injury: Lumbar

Spine Injury: Lumbar is a topic covered in the 5-Minute Emergency Consult.

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Basics

Description

  • Flexion compression fracture:
    • Wedge compression:
      • If <50% anterior compression of the vertebral body, injury considered stable
      • No ligamentous injury
      • No neurologic deficit
    • Burst fracture:
      • Vertebral body fracture with retropulsion of bone into the neural canal
      • Kyphosis evident on lateral radiograph
      • Posterior ligamentous injury
      • Anterior compression, lower extremities, calcaneal fractures
      • Possible neurologic deficit
  • Flexion distraction (lap belt injury):
    • Abdominal injuries likely
    • Chance fracture:
      • Purely bony injury; fracture line through spinous process, pedicles, and vertebral body
      • No kyphosis evident on lateral radiograph
      • Often no neurologic deficit
    • Facet dislocation:
      • Mostly soft tissue injury; no fracture
      • Complete disruption of posterior ligaments and intervertebral disc
      • Neurologic deficit may be present.
  • Flexion rotation:
    • Unstable injury
    • Neurologic deficit often present
  • Extension:
    • Unstable, uncommon
    • Disruption of anterior longitudinal ligament and intervertebral disc
    • Neurologic sequelae rare but possible
  • Shear injuries (translational injuries):
    • Anterior, posterior, or lateral translation of superior vertebral segment over the inferior segment
    • Complete ligamentous disruption
    • Neurologic deficit present
  • Simple fractures:
    • Isolated spinous process fracture:
      • Ligamentous disruption
      • No neurologic deficit
    • Isolated transverse process fracture:
      • Ligamentous disruption
      • Neurologic deficit possible; rare isolated root injury

Etiology

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

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 T12 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.

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Citation

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TY - ELEC T1 - Spine Injury: Lumbar ID - 307306 Y1 - 2016 PB - 5-Minute Emergency Consult UR - https://emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307306/all/Spine_Injury:_Lumbar ER -