Clinical Presentation

A woman with severe back pain after being in an automobile-pedestrian accident.

Further Work-up

(A) Sagittal computed tomography (CT) scan of the lumbar spine shows a fracture of the L4 vertebral body involving all the walls, with retropulsion of fragments toward the spinal canal (arrow). (B) Axial CT scan of the lumbar spine shows a fracture of the L4 vertebral body involving all the walls, with retropulsion of fragments toward the spinal canal (arrows). There is also fracture of the posterior elements. (C) Sagittal T2-weighted image (WI) shows, in addition to the deformity of L4, bone marrow edema at L4 and L5. The narrowing of the canal and its effect on the cauda equina (arrow) are better demonstrated. (D) Axial T2WI shows flattening of the thecal sac (arrow) secondary to stenosis caused by the posteriorly displaced fracture fragments.

Differential Diagnosis

• Burst fracture: This is a compression fracture in which the entire vertebral body breaks. It results from axial loading that is most often secondary to motor vehicle accidents and falls. The axial load drives the intervertebral disk into the vertebral body below.