Medscape is available in 5 Language Editions – Choose your Edition here.


Lumbosacral Spine Acute Bony Injuries Clinical Presentation

  • Author: Federico C Vinas, MD; Chief Editor: Sherwin SW Ho, MD  more...
Updated: Sep 30, 2013


In the assessment of an injured athlete, the history should include a description of the trauma and an exact description of the pain and any exacerbating factors. A past history of any spinal problem should always be obtained. Patients with lumbosacral fractures present with severe pain, deformity, and neurologic deficits related to compression of neural structures.

In healthy athletes, a significant traumatic event is required to produce a fracture of the lumbar spine, whereas in patients with caused by metabolic or endocrine imbalance, a relatively minor trauma can produce a pathologic fracture.

Any neurologic change at the time of the event, such as weakness, paresthesias, or radicular pain, should be documented. For example, lumbar fractures may cause solitary or multiple radiculopathies. Massive disc herniations, fracture-dislocations, and burst fractures can cause a cauda equina syndrome with variable paraparesis, asymmetrical saddle anesthesia, radiating pain, and sphincter disturbances. Complete damage of the sacral cord and nerve roots is manifested as no motor function or sensation below L1.

  • Classification
    • The most useful classification of lumbar spine fractures is Denis's 3-column spine stability classification.[34, 35] According to this model, the spine consists of 3 columns.
    • The anterior column is represented by the anterior half of the vertebral body, the anterior half of the annulus fibrosus, and the anterior longitudinal ligament.
    • The middle column consists of the posterior half of the vertebral body, the posterior half of the annulus fibrosus, and the posterior longitudinal ligament.
    • The posterior column is represented by the supraspinous and infraspinous ligaments, ligamentum flavum, articular processes, joint capsules, spinous processes, and the laminae.
    • Instability occurs when 2 or more columns are injured. Because contiguous columns are commonly affected by the same injury, instability is heavily dependent on middle column failure.
    • Magerl and colleagues proposed a classification scheme with 3 morphologic injury patterns, types A, B, and C, which result from 3 basic forces, compression, distraction, and rotation, respectively.[36] These categories have been applied to all levels of the spine, and subcategories and subdivisions have been described based on the mechanism and severity of the fractures.
  • Mechanism of injury and relative force sustained
    • A detailed history must be obtained, if possible, to ascertain the mechanism of injury and the relative force sustained.
    • Individuals who fall often receive hyperflexion or compression injuries, such as spinous process fractures, burst fractures, or traumatic spondylolisthesis. These injuries are commonly associated with pelvic and lower-extremity fractures.
    • Automobile racers who were using seat belts during motor vehicle accidents often receive compression or distraction injuries to the spine, which are frequently associated with cervical spine injuries. In these patients, burst fractures and fractures dislocations are relatively common.
    • Head injuries and extremity fractures commonly accompany vertebral fractures.
    • Abdominal or urologic trauma can occur frequently in patients with lumbar fractures.
    • The possible presence of concurrent direct injuries to adjacent intracavitary soft-tissue structures, such as renal, spleen, or liver lacerations, must be considered. In general, the more caudal the vertebral injury, the greater the biomechanical forces that are sustained and the greater the propensity for injuries to the pelvis and sacrum.

Related Medscape Reference topics:

Lower Genitourinary Trauma

Upper Genitourinary Trauma



The initial management of patients with a lumbar spine injury begins in the field. Any patient who may have a spinal injury is placed on a board in a neutral supine position and immobilized in a neck collar for expeditious transportation to a trauma center. In the emergency department, all patients should be treated as having a spinal injury until this condition is excluded. Fractures of the thoracolumbar junction can produce a mixture of cord and root syndromes caused by lesions of the conus medullaris and lumbar nerve roots, whereas lower lumbar fractures may cause solitary or multiple root deficits.

The Advanced Trauma Life Support (ACLS) guidelines of the American College of Surgeons should be followed. Stabilization of the patient's airway and hemodynamic status in order to secure adequate oxygenation and tissue perfusion should precede any treatment. A Foley catheter should be inserted. In patients with neurologic deficit, immediate peritoneal lavage is often advocated to rule out intra-abdominal injuries. Once the patient has been resuscitated, plain films of the cervical, thoracic, and lumbosacral spine should be taken.

  • Physical examination
    • The physical examination of the athlete with an acute spinal fracture is usually limited by the patient's severe pain.
    • During the spinal examination, the overlying skin should be inspected for abrasions or contusions.
    • Attention should be directed to general deviations from the normal spine curves (ie, thoracic kyphosis, lumbar lordosis).
    • Muscle spasm from pain frequently flattens the spine, whereas spinal fractures may cause a kyphotic or scoliotic deformity.
    • The spine should be palpated for areas of tenderness or fractured, displaced spinous processes.
  • Neurologic examination
    • Sometimes, the initial examination of these patients can be difficult because of multiple trauma, spinal shock, or sedation. Any neurologic deficit should be documented according to the American Spinal Injury Association (ASIA) Motor Index.
    • A motor examination should be performed on all conscious patients. Muscle strength and weakness are graded based on a strength scale from 0 to 5, with 5 considered normal and 0 considered paralysis. Muscle strength grading is as follows:
      • Grade 0 – No contraction
      • Grade 1 – Flicker of movement
      • Grace 2 – Can move when gravity is eliminated
      • Grade 3 – Can elevate against gravity
      • Grade 4 – Can move against resistance (-4 for slight resistance, 4 for moderate resistance, and +4 for strong resistance)
      • Grade 5 – Normal strength
    • A detailed neurologic evaluation should include detection of a sensory level, posterior column function, and normal and abnormal reflexes and an examination of rectal tone and perianal sensation. The cutaneous abdominal reflex, bulbocavernosus, anal wink, and the presence of a Babinski sign should also be noted and documented. The Beevor sign consists of a cephalic movement of the umbilicus when the patient is asked to elevate the head in the supine position. This is due to paralysis of the lower abdominal muscles.
    • A rectal examination to check for rectal tone and voluntary sphincter function should always be included.
    • Repeated neurologic examinations should be performed and documented at regular intervals to serve as references for improvement or deterioration in the patient's neurologic status over time.
    • In patients with a complete spinal injury (paraplegia or quadriplegia), spinal shock can last 24-48 hours, suppressing all reflex activity below the level of the lesion. The return of reflex activity (bulbocavernosus and anal reflexes) in the absence of any return of sensation or motor function is generally a poor prognostic indicator. Some return of motor or sensory function below the level of the lesion encourages the possibility of some return of useful neurologic function.

Related Medscape resources:

Specialty Site Critical Care

Specialty Site Gastroenterology

Specialty Site Neurology & Neurosurgery

Specialty Site Orthopaedics

Specialty Site Surgery

Specialty Site Urology



The forces responsible for spinal fractures are compression, flexion, extension, rotation, shear, distraction, or a combination of these mechanisms. In athletes, the most common acute fractures are compression fractures (see the image below) or vertebral endplate fractures caused by sudden axial loading, transverse process avulsion by the origin of the psoas muscle, spinous process avulsions, and acute fracture of the pars interarticularis from hyperextension.[37]

Lateral plain radiograph. This image shows an L3 c Lateral plain radiograph. This image shows an L3 compression fracture.

See the list below:

  • Vertebral body compression is more common in athletes with decreased bone density from a cause such as exercise-induced amenorrhea. In adolescents, endplate fractures (Schmorl node) or apophyseal avulsion fractures are relatively common. All these injuries are generally stable and heal with immobilization and nonsurgical management.
  • Spinous process fractures may occur as a result of direct trauma to the posterior spine or as a result of forcible flexion and rotation. These injuries are not usually associated with neurologic deficits. Violent muscular contraction or direct trauma can cause fractures of the transverse processes. For example, a football helmet blow to the back can cause fractures of both spinal and transverse processes. Despite their relatively innocuous appearance, these fractures can cause significant bleeding into the retroperitoneal space, resulting in acute anemia, or ileus.
  • Sports that cause frequent hyperextension of the lumbar spine induce stress on the pars interarticularis. A defect in the pars interarticularis or spondylolysis is common in competitors in sports that require repetitive or prolonged hyperextension of the spine, such as tennis (the serve), volleyball (the spike), and track (the high jump). Athletes with back pain and spondylolysis fall into 2 main groups, (1) those with acute or subacute lesions related to a precipitating episode of hyperextension or trauma and (2) those with well-established, chronic spondylolysis. Although each of the following lesions in isolation can appear benign, the spinal column must be evaluated further to rule out additional injury.
    • Female gymnasts have an incidence of pars defects 4 times greater than the general population. This is presumably the result of gymnastics maneuvers that load the spine in hyperextension (eg, dismounts, back walkovers, aerials).
    • Other athletes at higher risk for pars spondylolysis include ballet dancers, divers, and football linemen.
    • Thoracolumbar fractures have been estimated to occur in 14% of snowmobile injuries, 5% of alpine skiing injuries, and 8% of freestyle skiing injuries.
    • Direct trauma from hockey- or football-related injuries can also cause a fracture of an articular process.
  • Acute traumatic spondylolisthesis is usually associated with major trauma and is usually caused by extreme hyperextension. Although patients with a new fracture of the pars interarticularis may have a slip present at the time of the injury, a slip can occur months to years later as the disc degenerates under shear loads that it cannot sustain.

Related Medscape Reference topics:

Degenerative Lumbar Disc Disease in the Mature Athlete

Degenerative Disk Disease

Female Athlete Triad

Lumbar Degenerative Disk Disease

Spondylolisthesis, Spondylolysis, and Spondylosis

Contributor Information and Disclosures

Federico C Vinas, MD Consulting Neurosurgeon, Department of Neurological Surgery, Halifax Medical Center

Federico C Vinas, MD is a member of the following medical societies: American Association of Neurological Surgeons, American College of Surgeons, American Medical Association, Florida Medical Association, North American Spine Society, Congress of Neurological Surgeons

Disclosure: Nothing to disclose.

Specialty Editor Board

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Received salary from Medscape for employment. for: Medscape.

Henry T Goitz, MD Academic Chair and Associate Director, Detroit Medical Center Sports Medicine Institute; Director, Education, Research, and Injury Prevention Center; Co-Director, Orthopaedic Sports Medicine Fellowship

Henry T Goitz, MD is a member of the following medical societies: American Academy of Orthopaedic Surgeons, American Orthopaedic Society for Sports Medicine

Disclosure: Nothing to disclose.

Chief Editor

Sherwin SW Ho, MD Associate Professor, Department of Surgery, Section of Orthopedic Surgery and Rehabilitation Medicine, University of Chicago Division of the Biological Sciences, The Pritzker School of Medicine

Sherwin SW Ho, MD is a member of the following medical societies: American Academy of Orthopaedic Surgeons, Arthroscopy Association of North America, Herodicus Society, American Orthopaedic Society for Sports Medicine

Disclosure: Received consulting fee from Biomet, Inc. for speaking and teaching; Received grant/research funds from Smith and Nephew for fellowship funding; Received grant/research funds from DJ Ortho for course funding; Received grant/research funds from Athletico Physical Therapy for course, research funding; Received royalty from Biomet, Inc. for consulting.

Additional Contributors

Andrew D Perron, MD Residency Director, Department of Emergency Medicine, Maine Medical Center

Andrew D Perron, MD is a member of the following medical societies: American College of Emergency Physicians, American College of Sports Medicine, Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

  1. Jones A, Andrews J, Shoaib A, et al. Avulsion of the L4 spinous process: an unusual injury in a professional rugby player: case report. Spine. 2005 Jun 1. 30(11):E323-5. [Medline].

  2. Tator CH, Provvidenza CF, Lapczak L, Carson J, Raymond D. Spinal injuries in Canadian ice hockey: documentation of injuries sustained from 1943-1999. Can J Neurol Sci. 2004 Nov. 31(4):460-6. [Medline].

  3. Hickey GJ, Fricker PA, McDonald WA. Injuries of young elite female basketball players over a six-year period. Clin J Sport Med. 1997 Oct. 7(4):252-6. [Medline].

  4. Halvorsen TM, Nilsson S, Nakstad PH. [Stress fractures. Spondylolysis and spondylolisthesis of the lumbar vertebrae among young athletes with back pain] [Norwegian]. Tidsskr Nor Laegeforen. 1996 Jun 30. 116(17):1999-2001. [Medline].

  5. Bennell KL, Malcolm SA, Thomas SA, et al. Risk factors for stress fractures in female track-and-field athletes: a retrospective analysis. Clin J Sport Med. 1995 Oct. 5(4):229-35. [Medline].

  6. Ekin JA, Sinaki M. Vertebral compression fractures sustained during golfing: report of three cases. Mayo Clin Proc. 1993 Jun. 68(6):566-70. [Medline].

  7. Razak M, Mahmud MM, Hyzan MY, Omar A. Short segment posterior instrumentation, reduction and fusion of unstable thoracolumbar burst fractures--a review of 26 cases. Med J Malaysia. 2000 Sep. 55 suppl C:9-13. [Medline].

  8. Stanislas MJ, Latham JM, Porter KM, Alpar EK, Stirling AJ. A high risk group for thoracolumbar fractures. Injury. 1998 Jan. 29(1):15-8. [Medline].

  9. Ryan M, Klein S, Bongard F. Missed injuries associated with spinal cord trauma. Am Surg. 1993 Jun. 59(6):371-4. [Medline].

  10. Williams B. Pathogenesis of post-traumatic syringomyelia. Br J Neurosurg. 1992. 6(6):517-20. [Medline].

  11. Browne TD, Yost RP, McCarron RF. Lumbar ring apophyseal fracture in an adolescent weight lifter. A case report. Am J Sports Med. 1990 Sep-Oct. 18(5):533-5. [Medline].

  12. Alexander MJ. Biomechanical aspects of lumbar spine injuries in athletes: a review. Can J Appl Sport Sci. 1985 Mar. 10(1):1-20. [Medline].

  13. Snook GA. Injuries in intercollegiate wrestling. A 5-year study. Am J Sports Med. 1982 May-Jun. 10(3):142-4. [Medline].

  14. Konermann W, Sell S. [The spine--a problem area in high performance artistic gymnastics. A retrospective analysis of 24 former artistic gymnasts of the German A team] [German]. Sportverletz Sportschaden. 1992 Dec. 6(4):156-60. [Medline].

  15. Letts M, Smallman T, Afanasiev R, Gouw G. Fracture of the pars interarticularis in adolescent athletes: a clinical-biomechanical analysis. J Pediatr Orthop. 1986 Jan-Feb. 6(1):40-6. [Medline].

  16. Ciullo JV, Jackson DW. Pars interarticularis stress reaction, spondylolysis, and spondylolisthesis in gymnasts. Clin Sports Med. 1985 Jan. 4(1):95-110. [Medline].

  17. Tewes DP, Fischer DA, Quick DC, Zamberletti F, Powell J. Lumbar transverse process fractures in professional football players. Am J Sports Med. 1995 Jul-Aug. 23(4):507-9. [Medline].

  18. Saal JA. Common American football injuries. Sports Med. 1991 Aug. 12(2):132-47. [Medline].

  19. Virgin HW. Football injuries to the skeletal system. Compr Ther. 1985 Jan. 11(1):19-24. [Medline].

  20. Bowerman JW, McDonnell EJ. Radiology of athletic injuries: football. Radiology. 1975 Oct. 117(1):33-6. [Medline].

  21. Gray BL, Buchowski JM, Bumpass DB, Lehman RA, Mall NA, Matava MJ. Disc Herniations in the National Football League. Spine (Phila Pa 1976). 2013 Sep 10. [Medline].

  22. Nagashima M, Abe H, Amaya K, Matsumoto H, Yanaihara H, Nishiwaki Y, et al. Risk Factors for Lumbar Disc Degeneration in High School American Football Players: A Prospective 2-Year Follow-up Study. Am J Sports Med. 2013 Sep. 41(9):2059-64. [Medline].

  23. Schroeder GD, McCarthy KJ, Micev AJ, Terry MA, Hsu WK. Performance-Based Outcomes After Nonoperative Treatment, Discectomy, and/or Fusion for a Lumbar Disc Herniation in National Hockey League Athletes. Am J Sports Med. 2013 Aug 16. [Medline].

  24. Wilson F, Gissane C, Gormley J, Simms C. Sagittal plane motion of the lumbar spine during ergometer and single scull rowing. Sports Biomech. 2013 Jun. 12(2):132-42. [Medline].

  25. Silver JR. Spinal injuries resulting from horse riding accidents. Spinal Cord. 2002 Jun. 40(6):264-71. [Medline]. [Full Text].

  26. Lin CY, Wright J, Bushnik T, Shem K. Traumatic spinal cord injuries in horseback riding: a 35-year review. Am J Sports Med. 2011 Nov. 39(11):2441-6. [Medline].

  27. Donald S, Chalmers D, Theis JC. Are snowboarders more likely to damage their spines than skiers? Lessons learned from a study of spinal injuries from the Otago skifields in New Zealand. N Z Med J. 2005 Jun 24. 118(1217):U1530. [Medline].

  28. Basu S, Makwana NK, Khazim R. Sledging related spinal injuries and fracture patterns: a report on five cases. Br J Sports Med. 1999 Oct. 33(5):357-8; discussion 359. [Medline]. [Full Text].

  29. Okamoto K, Doita M, Yoshikawa M, et al. Lumbar chance fracture in an adult snowboarder: unusual mechanism of a chance fracture. Spine. 2005 Jan 15. 30(2):E56-9. [Medline].

  30. Keene JS. Thoracolumbar fractures in winter sports. Clin Orthop Relat Res. 1987 Mar. 216:39-49. [Medline].

  31. Roberts VL, Noyes FR, Hubbard RP, McCabe J. Biomechanics of snowmobile spine injuries. J Biomech. 1971 Dec. 4(6):569-77. [Medline].

  32. Snook GA. A review of women's collegiate gymnastics. Clin Sports Med. 1985 Jan. 4(1):31-7. [Medline].

  33. Eismont FJ, Kitchel SH. Thoracolumbar spine. Delee JC, Drez D, eds. Orthopedic Sports Medicine: Principles and Practice. Philadelphia, Pa: WB Saunders Co; 1994. Vol 2: 1018-62.

  34. Denis F. The three column spine and its significance in the classification of acute thoracolumbar spinal injuries. Spine. 1983 Nov-Dec. 8(8):817-31. [Medline].

  35. Denis F. Spinal instability as defined by the three-column spine concept in acute spinal trauma. Clin Orthop Relat Res. 1984 Oct. 189:65-76. [Medline].

  36. Magerl F, Aebi M, Gertzbein SD, Harms J, Nazarian S. A comprehensive classification of thoracic and lumbar injuries. Eur Spine J. 1994. 3(4):184-201. [Medline].

  37. Rahme R, Moussa R. The modic vertebral endplate and marrow changes: pathologic significance and relation to low back pain and segmental instability of the lumbar spine. AJNR Am J Neuroradiol. 2008 May. 29(5):838-42. [Medline]. [Full Text].

  38. Lieberman JA, Lyon R, Feiner J, Hu SS, Berven SH. The efficacy of motor evoked potentials in fixed sagittal imbalance deformity correction surgery. Spine. 2008 Jun 1. 33(13):E414-24. [Medline].

  39. Lavelle WF, Lavelle ED, Smith HS. Interventional techniques for back pain. Clin Geriatr Med. 2008 May. 24(2):345-68, viii. [Medline].

  40. Korovessis P, Baikousis A, Zacharatos S, et al. Combined anterior plus posterior stabilization versus posterior short-segment instrumentation and fusion for mid-lumbar (L2-L4) burst fractures. Spine. 2006 Apr 15. 31(8):859-68. [Medline].

  41. Bailes JE Jr, Van der Veer CA. Surgical management of patients with sports-related spinal injuries. Clin Neurosurg. 2001. 48:243-59. [Medline].

  42. Razak M, Mahmud M, Mokhtar SA, Omar A. Thoracolumbar fracture--dislocation results of surgical treatment. Med J Malaysia. 2000 Sep. 55 suppl C:14-7. [Medline].

  43. Denis F, Burkus JK. Shear fracture-dislocations of the thoracic and lumbar spine associated with forceful hyperextension (lumberjack paraplegia). Spine. 1992 Feb. 17(2):156-61. [Medline].

  44. Karjalainen M, Aho AJ, Katevuo K. Operative treatment of unstable thoracolumbar fractures by the posterior approach with the use of Williams plates or Harrington rods. Int Orthop. 1992. 16(3):219-22. [Medline].

  45. Dai LY. Remodeling of the spinal canal after thoracolumbar burst fractures. Clin Orthop Relat Res. 2001 Jan. 382:119-23. [Medline].

  46. Denis F, Burkus JK. Diagnosis and treatment of cauda equina entrapment in the vertical lamina fracture of lumbar burst fractures. Spine. 1991 Aug. 16(8 suppl):S433-9. [Medline].

  47. Denis F, Burkus JK. Lateral distraction injuries to the thoracic and lumbar spine. A report of three cases. J Bone Joint Surg Am. 1991 Aug. 73(7):1049-53. [Medline]. [Full Text].

  48. Riggins MS, Kankipati P, Oyster ML, Cooper RA, Boninger ML. The relationship between quality of life and change in mobility 1 year postinjury in individuals with spinal cord injury. Arch Phys Med Rehabil. 2011 Jul. 92(7):1027-33. [Medline].

  49. Marino RJ, Burns S, Graves DE, Leiby BE, Kirshblum S, Lammertse DP. Upper- and lower-extremity motor recovery after traumatic cervical spinal cord injury: an update from the national spinal cord injury database. Arch Phys Med Rehabil. 2011 Mar. 92(3):369-75. [Medline].

  50. Abel MS. Jogger's fracture and other stress fractures of the lumbo-sacral spine. Skeletal Radiol. 1985. 13(3):221-7. [Medline].

  51. Aharony S, Milgrom C, Wolf T, et al. Magnetic resonance imaging showed no signs of overuse or permanent injury to the lumbar sacral spine during a Special Forces training course. Spine J. 2008 Jul-Aug. 8(4):578-83. [Medline].

  52. Benzel EC, Larson SJ. Postoperative stabilization of the posttraumatic thoracic and lumbar spine: a review of concepts and orthotic techniques. J Spinal Disord. 1989 Mar. 2(1):47-51. [Medline].

  53. Breitenfelder J. [Treatment of fractures of the vertebral body without involvement of the spinal cord or roots] [German]. Z Orthop Ihre Grenzgeb. 1972 Feb. 110(1):116-20. [Medline].

  54. Bötel U. [Classification and surgical indications in spinal injuries] [German]. Langenbecks Arch Chir Suppl Kongressbd. 1992. 263-70. [Medline].

  55. Centenera LV, Choi S, Hirsch JA. Percutaneous vertebroplasty treats compression fractures. Diagn Imaging (San Franc). 2000 Nov. 22(11):147-8, 153. [Medline].

  56. Clark JE. Apophyseal fracture of the lumbar spine in adolescence. Orthop Rev. 1991 Jun. 20(6):512-6. [Medline].

  57. Commandre FA, Taillan B, Gagnerie F, et al. Spondylolysis and spondylolisthesis in young athletes: 28 cases. J Sports Med Phys Fitness. 1988 Mar. 28(1):104-7. [Medline].

  58. Csermely T, Halvax L, Schmidt E, et al. [Lower bone density (osteopenia) in adolescent girls with oligomenorrhea and secondary amenorrhea] [Hungarian]. Orv Hetil. 1997 Oct 26. 138(43):2735-41. [Medline].

  59. Dennis S, Watkins R, Landaker S, Dillin W, Springer D. Comparison of disc space heights after anterior lumbar interbody fusion. Spine. 1989 Aug. 14(8):876-8. [Medline].

  60. Ferrandez L, Usabiaga J, Curto JM, Alonso A, Martin F. Atypical multivertebral fracture due to hyperextension in an adolescent girl. A case report. Spine. 1989 Jun. 14(6):645-6. [Medline].

  61. Garth WP Jr, Van Patten PK. Fractures of the lumbar lamina with epidural hematoma simulating herniation of a disc. A case report. J Bone Joint Surg Am. 1989 Jun. 71(5):771-2. [Medline]. [Full Text].

  62. Greenan TJ. Diagnostic imaging of sports-related spinal disorders. Clin Sports Med. 1993 Jul. 12(3):487-505. [Medline].

  63. Hakalo J, Wronski J. [Complications of a transpedicular stabilization of thoraco-lumbar burst fractures] [Polish]. Neurol Neurochir Pol. 2006 Mar-Apr. 40(2):134-9. [Medline].

  64. Haussler KK, Stover SM. Stress fractures of the vertebral lamina and pelvis in Thoroughbred racehorses. Equine Vet J. 1998 Sep. 30(5):374-81. [Medline].

  65. Hopkins TJ, White AA 3rd. Rehabilitation of athletes following spine injury. Clin Sports Med. 1993 Jul. 12(3):603-19. [Medline].

  66. Hulkko A, Orava S. Diagnosis and treatment of delayed and non-union stress fractures in athletes. Ann Chir Gynaecol. 1991. 80(2):177-84. [Medline].

  67. Jeanneret B, Gebhard JS, Magerl F. Transpedicular screw fixation of articular mass fracture-separation: results of an anatomical study and operative technique. J Spinal Disord. 1994 Jun. 7(3):222-9. [Medline].

  68. Kahler RJ, Knuckey NW, Davis S. Arachnoiditis ossificans and syringomyelia: a unique case report. J Clin Neurosci. 2000 Jan. 7(1):66-8. [Medline].

  69. Keynan O, Fisher CG, Vaccaro A, et al. Radiographic measurement parameters in thoracolumbar fractures: a systematic review and consensus statement of the Spine Trauma Study Group. Spine. 2006 Mar 1. 31(5):E156-65. [Medline].

  70. Knop C, Fabian HF, Bastian L, Blauth M. Late results of thoracolumbar fractures after posterior instrumentation and transpedicular bone grafting. Spine. 2001 Jan 1. 26(1):88-99. [Medline].

  71. Kösling S, Dietrich K, Steinecke R, Klöppel R, Schulz HG. Diagnostic value of 3D CT surface reconstruction in spinal fractures. Eur Radiol. 1997. 7(1):61-4. [Medline].

  72. Levi AD, Hurlbert RJ, Anderson P, et al. Neurologic deterioration secondary to unrecognized spinal instability following trauma--a multicenter study. Spine. 2006 Feb 15. 31(4):451-8. [Medline].

  73. Massari L, Chiarelli GM, Lupi L, Bighi S. Fractures of the posterior apophyseal ring of the lumbar vertebral body in young patients. Three cases. [English, Italian]. Chir Organi Mov. 1990 Apr-Jun. 75(2):129-33. [Medline].

  74. Matejka J. [Hyperextension injuries of the thoracolumbar spine] [German]. Zentralbl Chir. 2006 Feb. 131(1):75-9. [Medline].

  75. Mazel C. [Spondylolisthesis in athletes] [French]. Presse Med. 1991 Apr 6. 20(13):596-600. [Medline].

  76. Moller A, Hasserius R, Besjakov J, Ohlin A, Karlsson M. Vertebral fractures in late adolescence: a 27 to 47-year follow-up. Eur Spine J. 2006 Aug. 15(8):1247-54. [Medline].

  77. Nabeshima Y, Iguchi T, Matsubara N, et al. Extension injury of the thoracolumbar spine. Spine. 1997 Jul 1. 22(13):1522-5; discussion 1525-6. [Medline].

  78. Parvataneni HK, Nicholas SJ, McCance SE. Bilateral pedicle stress fractures in a female athlete: case report and review of the literature. Spine. 2004 Jan 15. 29(2):E19-21. [Medline].

  79. Ryan PJ, Evans P, Blake GM, Fogeman I. The effect of vertebral collapse on spinal bone mineral density measurements in osteoporosis. Bone Miner. 1992 Sep. 18(3):267-72. [Medline].

  80. Ryan PJ, Fogelman I. Osteoporotic vertebral fractures: diagnosis with radiography and bone scintigraphy. Radiology. 1994 Mar. 190(3):669-72. [Medline]. [Full Text].

  81. Sicard A, Lavarde G. [Treatment of fractures of the thoracic and lumbar spine without neurological complications] [French]. Presse Med. 1969 Jan 4. 77(1):5-8. [Medline].

  82. Stavrev P. Thoracolumbar spine stabilization in fracture--dislocations. Folia Med (Plovdiv). 1994. 36(4):59-65. [Medline].

  83. Teitz CC, Cook DM. Rehabilitation of neck and low back injuries. Clin Sports Med. 1985 Jul. 4(3):455-76. [Medline].

  84. Tschoeke SK, Hellmuth M, Hostmann A, et al. Apoptosis of human intervertebral discs after trauma compares to degenerated discs involving both receptor-mediated and mitochondrial-dependent pathways. J Orthop Res. 2008 Jul. 26(7):999-1006. [Medline].

  85. Van der Wall H, Magee M, Reiter L, Frater CJ, Qurashi S, Loneragan R. Degenerative spondylolysis: a concise report of scintigraphic observations. Rheumatology (Oxford). 2006 Feb. 45(2):209-11. [Medline]. [Full Text].

  86. Vollmer DG, Gegg C. Classification and acute management of thoracolumbar fractures. Neurosurg Clin N Am. 1997 Oct. 8(4):499-507. [Medline].

  87. Yoon SH, Miyazaki M, Hong SW, et al. A porcine model of intervertebral disc degeneration induced by annular injury characterized with magnetic resonance imaging and histopathological findings. Laboratory investigation. J Neurosurg Spine. 2008 May. 8(5):450-7. [Medline].

Lateral plain radiograph. This image shows an L3 compression fracture.
A computed tomography scan with sagittal reconstructions allows better visualization of the compression fracture.
Sagittal T1-weighted magnetic resonance imaging study of a professional driver who was in a rollover motor vehicle accident while racing his car. This figure shows a T-10 unstable burst fracture producing severe kyphotic deformity of the spine. The abnormal signal on the vertebral body and the extradural defect represents a subacute hematoma producing spinal cord compression. The patient had severe paraparesis and underwent an emergency operation. The procedure involved an anterolateral retroperitoneal approach with a corpectomy and vertebral reconstruction.
Postoperative plain x-ray film of a professional driver who experienced a burst fracture in a rollover motor vehicle accident while racing his car. This image shows a vertebral reconstruction with the use of a titanium cage filled with bone and the arthrodesis with a Z plate.
Axial computed tomography scan of an athlete who had a hyperextension injury that resulted in disruption of the posterior spinal elements. This patient had compromise of the anterior and middle spinal columns, resulting in an unstable fracture.
Computed tomography scanning with 3-dimensional reconstruction facilitates the assessment of some complex fractures. In this case, the patient experienced a severe compression fracture.
Sagittal computed tomography scan reconstruction of an athlete who had a burst fracture.
Computed tomography scan with coronal reconstruction of an athlete who had multiple compression fractures.
Magnetic resonance image of a young female with a severe unstable fracture of L4. The patient had a partial neurologic deficit and required urgent surgical fixation.
Postoperative radiograph of a patient status post reduction, fusion, and internal fixation of an unstable fracture. Note that the anatomic alignment has been restored.
Sagittal computed tomography scan reconstruction of a young female who had a skydiving accident. The parachute deployed, but the patient landed on concrete and sustained a lower-extremity fracture and a fracture of L1. She was neurologically intact but required an open reduction with a fusion and instrumental fixation of the fracture.
All material on this website is protected by copyright, Copyright © 1994-2016 by WebMD LLC. This website also contains material copyrighted by 3rd parties.