Traumatic Lumbar Fracture

Presentation

An 18-year-old woman was hit by a car and sustained multisystemic injury. On presentation she was paraplegic and had complete spinal cord injury in the lower extremities. She had a prolonged intensive care unit course and was finally stable enough for surgery.

FIGURE 13-1 CT AP reconstruction of the thoracolumbar junction shows an L1–L2 fracture dislocation.

Radiologic Findings

Anteroposterior (AP) reconstruction of the thoracolumbar junction shows an L1–L2 fracture dislocation. An axial slice through the area demonstrates the rotational translation of L1 on L2 (Figs. 13-1 and 13-2).

Diagnosis

Fracture dislocation of the lumbar spine

FIGURE 13-2 An axial CT slice through the area demonstrates the rotational translation of L1 on L2.

**TABLE 13-1** The Surgical Approaches to the Spine
Approach/Level	Ventral	Ventrolateral	Dorsolateral	Dorsal
C6-T3	Cervicothoracic	—	Lat. parascapular extrapleural	Transpedicular Translaminar
T3-T10	Transthoracic	Retropleural	Lat. extracavitary	Transpedicular Translaminar
T10-L5	Thoracoabdominal	Retroperitoneal	Costotransversectomy	Transpedicular Translaminar

Treatment

Decompression, reduction, and thoracolumbar pedicle screw fixation were undertaken through a posterior approach.

Discussion

Fracture dislocations of the spine are the result of severe forces that disrupt all three columns by combining rotation, tension, compression, and shear. Flexion rotation fractures often occur through the disc space. These are associated with abdominal injury and neurologic damage. Treatment focuses on realignment of the spinal column, posterior stabilization, and early mobilization.

The surgical approach of a thoracolumbar fracture depends on location, mechanism of injury, neurologic status, and overall clinical status. Table 13-1 summarizes the approaches.