A novel asymmetric horizontal splitting fracture of the lumbar spine: pediatric case report of a lateral bending, flexion and distraction fracture

Abstract

Background

There are many lateral bending fracture cases presented in the literature that mostly involve facet dislocations or corpus collapse. In this report, we aim to describe a novel asymmetric lateral bending, flexion and distraction fracture, propose a mechanism, and delineate its clinical importance.

Case Description

A 13-year-old girl arrived at our trauma center 12 hours after a head-on truck collision. She had paraplegia, and her imaging revealed a spinal cord avulsion at the T10 level and a horizontal fracture at the L4 spinous process, left lamina, left pedicle, and left posterior-upper corner of the corpus, extending through the right lamina. Her posterior ligamentous complex, right facet joint, pedicle, and right side of the corpus were spared from the injury. The patient stated that she had been sitting on the right side of the back seat, turned toward her cousin in the middle. Her left leg was externally rotated and flexed on the seat while her right foot was on the floor at the time of the accident. The patient was managed conservatively with an orthosis. At follow-up, the patient was free of back pain and no lumbar kyphosis developed.

Conclusion

The flexion-distraction injuries mostly require surgical stabilization according to TLICS classification, because of the instability. In this particular case, TLICS classification was not adequate for a treatment decision, and the conservative treatment came out to be a more than sufficient treatment option.