Chance-type flexion-distraction fracture of lumbar spine

ABSTRACT

A 20-years old male, motor mechanic was working in kneeling position. His buttocks were resting on his heels with the back facing the bumper of a close-by van. His fellow colleague in the driving seat accidently ran the van forward and the bumper of the van hit the lumbar region of the patient with a tremendous force. He was brought to the emergency room two weeks later and was found to have bruises in the lumbar region with complete flaccid paraplegia and incontinence of both urine and faeces since the time of injury. Plain X-ray film and computed tomographic scanning with 3-D imaging revealed a shearing of spine with fracture line completely slicing through the second lumbar [L2] vertebra going across all the three vertebral columns. There was significant backward listhesis of upper fragment [along with the whole vertebral column above] of sliced L2 vertebra on the lower segment resulting in complete anatomical transection at this level. He was treated with strict immobilization and bed rest, taking all the measures of protecting the unstable spine. He was provided with intensive supportive care, nursing and physiotherapeutic rehabilitation. At three months, he was propped up in a lumbar corset and further rehabilitated in a wheel chair. This patient showed no neurological recovery till the last clinical follow up at 12 months and remained wheel chair-bound with complete paraplegia and double incontinence