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Spinal Injury: Lumbar Reviewed 10/2010

Bret E. Ginther
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BASICS

  • Description
  • Etiology

DIAGNOSIS

  • Signs and Symptoms
  • Essential Workup
  • Tests
  • Differential Diagnosis

TREATMENT

  • Pre-hospital
  • Initial Stabilization
  • ED Treatment
  • Medication (Drugs)
  • In-patient Considerations

ONGOING CARE

  • Follow-Up Recommendations
The following is an excerpt....
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 ...

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See Also
Images >
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FIG. 9 A: Low back pain with small contained prolapse, L-5 to S-1, and high signal-intensity zone at L4-5. B,C: Major concordant pain responses by clinical distention at each level.Credit: John W. Frymoyer, Sam W. Wiesel etal. The Adult and Pediatric Spine. Philadelphia: Lippincott Williams & Wilkins, 2004.