Spine Injury: Lumbar
Basics
Description
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
- Wedge compression:
- Flexion distraction (lap belt injury):
- Abdominal injuries commonly associated
- Chance fracture:
- Pure 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
- Isolated spinous process fracture:
Etiology
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
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
Schaider, Jeffrey J., et al., editors. "Spine Injury: Lumbar." 5-Minute Emergency Consult, 6th ed., Lippincott Williams & Wilkins, 2020. Emergency Central, emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307725/all/Spine_Injury:_Lumbar.
Spine Injury: Lumbar. In: Schaider JJJ, Barkin RMR, Hayden SRS, et al, eds. 5-Minute Emergency Consult. Lippincott Williams & Wilkins; 2020. https://emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307725/all/Spine_Injury:_Lumbar. Accessed December 10, 2024.
Spine Injury: Lumbar. (2020). In Schaider, J. J., Barkin, R. M., Hayden, S. R., Wolfe, R. E., Barkin, A. Z., Shayne, P., & Rosen, P. (Eds.), 5-Minute Emergency Consult (6th ed.). Lippincott Williams & Wilkins. https://emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307725/all/Spine_Injury:_Lumbar
Spine Injury: Lumbar [Internet]. In: Schaider JJJ, Barkin RMR, Hayden SRS, Wolfe RER, Barkin AZA, Shayne PP, Rosen PP, editors. 5-Minute Emergency Consult. Lippincott Williams & Wilkins; 2020. [cited 2024 December 10]. Available from: https://emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307725/all/Spine_Injury:_Lumbar.
* Article titles in AMA citation format should be in sentence-case
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