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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

Rosen, Peter, et al., editors. "Spine Injury: Lumbar." 5-Minute Emergency Consult, 5th ed., Lippincott Williams & Wilkins, 2016. Emergency Central, emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307306/all/Spine_Injury:_Lumbar.
Spine Injury: Lumbar. In: Rosen P, Shayne P, Barkin AZ, et al, eds. 5-Minute Emergency Consult. 5th ed. Lippincott Williams & Wilkins; 2016. https://emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307306/all/Spine_Injury:_Lumbar. Accessed April 24, 2019.
Spine Injury: Lumbar. (2016). In Rosen, P., Shayne, P., Barkin, A. Z., Wolfe, R. E., Hayden, S. R., Barkin, R. M., & Schaider, J. J. (Eds.), 5-Minute Emergency Consult. Available from https://emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307306/all/Spine_Injury:_Lumbar
Spine Injury: Lumbar [Internet]. In: Rosen P, Shayne P, Barkin AZ, Wolfe RE, Hayden SR, Barkin RM, Schaider JJ, editors. 5-Minute Emergency Consult. Lippincott Williams & Wilkins; 2016. [cited 2019 April 24]. Available from: https://emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307306/all/Spine_Injury:_Lumbar.
* Article titles in AMA citation format should be in sentence-case
TY - ELEC T1 - Spine Injury: Lumbar ID - 307306 ED - Rosen,Peter, ED - Shayne,Philip, ED - Barkin,Adam Z, ED - Wolfe,Richard E, ED - Hayden,Stephen R, ED - Barkin,Roger M, ED - Schaider,Jeffrey J, BT - 5-Minute Emergency Consult UR - https://emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307306/all/Spine_Injury:_Lumbar PB - Lippincott Williams & Wilkins ET - 5 DB - Emergency Central DP - Unbound Medicine ER -