L1 compression fracture in a trauma patient

BACKGROUND

Thoraco-lumbar spine injury commonly occurs after blunt polytrauma and up to one third of these injuries may result in spinal cord injury. To prevent neurological complications and ensure optimal results, management must include rapid assessment, suitable imaging and urgent treatment.

CASE PRESENTATION

A 60 year old male presented to A&E after falling 8 feet off a ladder. He landed on his right side and had very brief loss of consciousness. He was examined and had xrays of his C-spine and chest. The chest xray demonstrated right clavicular fracture, dislocation of right acromioclavicular joint, comminuted but minimally displaced fracture of right scapular blade and 4th-7th rib fractures on right side. A CT of the shoulder was done to further study the injury to the right shoulder. He was discharged  but represented the following week with severe lower back painlimiting mobility.The patient was immobilised, log rolled and admitted.

INVESTIGATIONS

X-ray of the thoraco-lumbar spine suggested a compression fracture of L1. Whilst a CT of the thoraco-lumbar spine revealed a fracture of the L1 vertebra.Using the three-column classification of spinal injuries of Denis, this proved to be an unstable 3 column fracture of L1.

TREATMENT

The operation performed was a T11-L1 osteosynthesis. Initially, a midline prone incision using the wiltse approach was made then pedicle screws as well as rods were inserted at T11, T12 and L1. The anterior cortex was breached and bone graft inserted. Finally after a washout, the subcutaneous layers and skin were closed.