Extension-distraction fracture of the first lumbar vertebra.

Abstract

This is a case report of an unusual fracture of the first lumbar vertebra in which the mechanism of injury appears to have been an extension-distraction force. The case report elucidates the patient's initial presentation at the time of injury, the treatment instituted, and follow-up revealing satisfactory healing of the fracture 18 months later. The case is reported to illustrate an usual injury that had not been previously reported. History, physical examination, and imaging studies from the time of injury, after initial treatment, and at final follow-up are presented. A case report is presented in which a fall subjected a patient's stiff, osteopenic spine to an extension moment, resulting in tension failure of the bony elements of the anterior and middle columns. Plain radiographs, tomograms, and a magnetic resonance image detail the injury pattern; plain radiographs are presented as follow-up images. Nonoperative treatment in this case led to a satisfactory outcome at 18 months follow-up. An unusual extension-distraction fracture of the spine is presented, which, in this case, was satisfactorily treated nonoperatively.