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Question
Fall from a height of 6 feet with back pain. Plain film shown. What is the diagnosis? Any further imaging indicated? Treatment? Disposition?
Answer
The question that must be answered is, is this a compression fracture or a burst fracture. A compression fracture without any retropulsion into the canal and any other associated injuries is a stable fracture that can be managed with pain control, out patient follow up and possible kyphosplasty for significant loss of vertebral height. A burst fracture is inherently unstable and is a risk for spinal cord injury. CT imaging answers are questions most efficiently.
To help distinguish burst from compression: “Burst fractures are a type of compression fracture related to high-energy axial loading spinal trauma that results in disruption of a vertebral body endplate and the posterior vertebral body cortex. Retropulsion of posterior cortex fragments into the spinal canal is frequently included in the definition. However, some authors, including the popular AO spine classification system, define a burst fracture as any axial compression fracture involving an endplate and the posterior cortex regardless of retropulsion." 2
(A and B) Axial CT images showing the burst fracture with extension of the fracture into the base of the spinous process (arrow). Coronal (C) and sagittal (D) CT images demonstrating spinal instability with retropulsion of a fracture fragment into the spinal canal. 3
References
1. https://radiopaedia.org/cases/acute-l1-burst-compression-fracture
3. https://radiopaedia.org/articles/burst-fracture?lang=us