Seizure-induced thoracolumbar burst fractures - Not to be missed

Abstract

While rare, post-ictal thoracolumbar burst fractures are commonly missed due to confounding factors, resulting in delayed treatment and the potential for serious neurological deficits. This paper serves as a call for a high-degree of clinical suspicion when treating post-ictal patients to ensure they undergo a focused neurological examination of the lower extremities. If unresponsive/uncooperative, spinal precautions should be maintained until the spine can be cleared clinically or radiographically. In all events, if the patient is complaining of musculoskeletal pain possibly originating from the spine, radiographic evaluations are warranted to prevent possible deficits caused by a missed thoracolumbar fracture.

Keywords: Diagnosis; Lumbar burst fracture; Seizure; Thoracic burst fracture.

Fig. 1

a. Sagittal T2 weighted MRI of the lumbosacral spine demonstrates severe spinal canal stenosis at the L1 level from osseous retropulsion of approximately 8 mm. b. Axial T2 weighted MRI demonstrates abnormal signal intensity within the conus consistent with acute injury.

Fig. 2

Lateral x-ray of the thoracolumbar spine demonstrating post-operative stabilization from T11-L3.