Lumbar Burst Fracture

HISTORY: A 20 year old white male who is a member of the ice hockey team who presents with a 2 day history of low back pain. He reports that he slipped on an icy patch of mulch, falling awkwardly. He describes developing significant LBP since that time. The pain is well localized to the back. It is exacerbated by any type of movement or activity, especially moving from a sit to stand position. He is not sleeping well reporting only a few hours a night due to the pain. He denies any weakness of his lower extremities, any bowel or bladder changes or any lower extremity parasthesias.

PHYSICAL EXAMINATION: Male laying prone on the examination table in discomfort. Limited lumbar flexion secondary to pain and mild reproduction of pain with lumbar extension. Point tenderness to palpation of the mid lumbar spine. No surface bruising or ecchymosis present. Normal lower extremity strength, sensation is intact distally at the L3, L4, L5 and S1 dermatomes. DTRs are 2-3+ at the ankles and patellas with downgoing plantar reflexes.

DIFFERENTIAL DIAGNOSIS:
1. Lumbar muscle strain
2. Lumbar ligamentous sprain
3. Lumbar disc protrusion
4. Lumbar spine fracture

TEST AND RESULTS:
Lumbar spine radiographs: AP view with increased pedicle distance at L1, implies posterior arch disruption; lateral view with compression fracture of L1 with greater than 50% loss of vertebral body height and retropulsion of bony fragments

FINAL/WORKING DIAGNOSIS: L1 Burst Fracture

TREATMENT AND OUTCOMES:
1. Immobilization on a spine board for transfer to medical center
2. Lumbar spine surgery fixation
3. Return to skating 3 months post injury and completed senior season without problems or difficulties