Spinal Fracture, Thoracolumbar


Step 1: View clinicals

A 25-year-old man is brought in 25 minutes after a motor vehicle accident. He was the front seat passenger and wore a seatbelt at that time. He now complains of excruciating lower back pain, described as 10/10 on the visual analog scale. The primary survey shows no threats to his airway, circulation, or breathing, while his GCS is 15/15, and both pupils are equal and reactive. X-rays of the cervical spine and chest show no evidence of fractures.

Step 2: Order all relevant investigations

FAST scan

The FAST scan shows no evidence of free fluid.

CT Spine

There is a compression fracture of the L4 vertebra, with minor loss of vertebral body height. The spinous processes and articular facets appear normal. The alignment of the anterior and posterior vertebral body lines has not been disrupted. The interspinous spaces are not widened.

MRI Spine

The MRI reveals a compression fracture of the L4 vertebra. The posterior ligamentous complex is intact. The spinal cord and nerve roots appear normal.

Skeletal Survey

You realize that a skeletal survey is not indicated right now.

Step 3: Select appropriate management

Venous thromboembolism prophylaxis
Opioid analgesia
Thoracolumbosacral orthosis
L4 vertebroplasty

Score: ★★☆