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32-year-old male presents to the emergency department following a motor vehicle accident. A radiograph is shown in Figure A, and a sagittal and axial CT scan are shown in Figure B and C respectively. What is the most likely mode of failure of the posterior spinal column?
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The clinical presentation and imaging studies are consistent with a flexion-distraction injury of the lumbar spine. The mode of failure of the posterior column is tension.
Jeanneret et al. described seven cases of a previously undescribed lesion of the lumbar spine consisting of a burst fracture of the vertebral body associated with a posterior subluxation of the adjacent lower level facet joints are described. They postulated that the lesion is due to a flexion-distraction mechanism, and due to the inherent instability recommend surgical reduction of the posterior subluxation, reduction of the burst fracture with anterior distraction, transpedicular bone grafting of the burst fracture if necessary, and fusion of the destroyed motion segment(s).
Mikles et al discuss the classification and treatment of thoracolumbar fractures. They state that most compression and stable burst fractures should be treated nonsurgically. Patients with unstable burst fractures and neurologic deficits require direct or indirect decompression.
Jeanneret B, Ho PK, Magerl F.
J Spinal Disord. 1993 Dec;6(6):473-81. PMID: 8130396 (Link to Abstract)
Jeanneret, JSDT 1993
Mikles MR, Stchur RP, Graziano GP
J Am Acad Orthop Surg. 2004 Nov-Dec;12(6):424-35. PMID: 15615508 (Link to Abstract)
Mikles, JAAOS 2004
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HPI - The patient is a 40 yo male that was involved in a motor vehicle accident. He was brought to the emergency room via an ambulance. He complained of severe low back pain, but without pain radiating into the legs. He denied subjective weakness in his lower extremities, but reports he is having difficulty with urination because of the pain he is in.
Would you operate on this patient?