e-CASES: Thoracic Injuries, Spinal Injuries L5, Traumatic disc herniation
29-year old blind patient, victim of a fall from a height of 5 m over a stand barrier in a stadium during a soccer match.The initial clinical examination revealed significant lumbar pain. The motricity examination was 5/5 on all the muscle groups. Normal sensitivity and all osteotendinous reflexes present. Perineal sensitivity and anal tonicity normal. Urinary catheterization performed for comfort in the emergency room. Sensitivity of left iliac fossa, with no abdominal guarding.
Here is the body scan:
- No traumatic lesions in the cervicoencephalic spaces.
- Pulmonary parenchymatous contusions limited to the left inferior lobe and to the right costovertebral groove with hematocele and pneumatoceles.
- Left hemoretroperitoneum with no active bleeding, caused by a dislocation fracture of L5 in flexion-distraction. The latter comprises grade II anterolisthesis of L5 on S1, bilateral biarticular fracture-dislocation of L5: unstable fracture++ with probable extensive posterior disk-ligament damage. Fracture of spinous and left transverse processes of L2 to L5. Possible posterior epidural hematoma in CT (corresponding to traumatic disk herniation in the MRI).
- No traumatic lesions of the intra-abdominal organs (benign biliary hepatic cysts).
Thoracic Injuries, Spinal Injuries L5, Traumatic disc herniation
The spinal fracture was reduced in the operating theatre and fixated via posterior arthrodesis. The hepatic contusion was simply monitored and progressive regression was observed on subsequent check-up CTs.
The pulmonary contusions and lacerations were also simply monitored.
- The various acquisition phases must be carefully examined to determine the nature of a focal hyperdensity (especially blood versus bone).
- In all cases of hemoretroperitoneum, a potential spinal origin should be sought.
- The content of the vertebral canal (in "soft tissue" windows) should be examined in cases of dislocation fracture to detect epidural hematoma or a posttraumatic herniated disk (therapeutic value++).