A 30 yo F with no past medical history presents to the ED after fall from a 3rd story window. She appears clinically intoxicated and admits to ETOH. She is complaining of severe lower back pain. On exam, there are no step-offs, but there is significant midline tenderess in the lower thoracic and lumbar region. A CT is done. What's the diagnosis? (see below for answer)  

Answer: L2 burst fracture with retropulsion

• Fractures of the thoracolumbar spine are most common at the junction of the T-L spine 
• 50% of thoracolumbar spinal fractures occur between T11 and L3
• Spinal columns = posterior, middle, anterior
• Anterior= anterior longitudinal ligament + anterior half of vertebral bodies
• Middle= posterior longitudinal ligament + posterior half of vertebral bodies
• Posterior= supraspinous ligament + interspinous ligament +facet joints + spinous processes
• Thoracolumbar spinal fractures are considered unstable if > 1 spinal column is disrupted
• In burst fractures, the antierior and middle spinal colummns are both disrupted--> unstable
• Other unstable fractures of the thoracic/lumbar spine include: Chance fracture, translational injuries and flexion-distraction injuries
• Stable fractures: wedge compression fracture, transverse process fracture, spinous process fracture
• CT is more sensitive than X-ray for detecting spinal fractures
• In this patient, retropulsion into the spinal canal resulted in severe spinal canal stenosis/cauda equina syndrome, requiring emergent surgery

References:

Ali K. Thoracolumbar Spine Trauma. In: Sherman SC. eds.Simon’s Emergency Orthopedics, 7eNew York, NY: McGraw-Hill; 2014.