Neglected lumbar traumatic spine injury after falling from a tree

Abstract

This 48-year-old man, previously healthy, presented with a six-month history of progressive low back pain and bilateral pseudo-sciatica of the lower extremities without sphincter disturbances. Physical examination revealed fixed kyphotic posture of the lumbar spine. Straight leg test and tendon reflexes were normal without any neurologic deficits. He reported sustaining a traumatic injury two years earlier secondary to a fall from a tree. At that time, he did not seek medical treatment. Plain radiograph (A) demonstrated regional lumbar kyphosis from L1 to L3 as well as a healed burst fracture of L2 vertebra (star). Spinal lumbar computed tomography scan (B-C) confirmed traumatic kyphotic deformity at L1-L2-L3 and moderate central stenosis at L2. There was also a new joint surface formation and vacuum phenomenon between the anterior vertebral bodies of L1 and L3. The patient was counseled on the need for surgery, but he refused any surgical intervention and insisted on conservative management. Neglected lumbar spinal injuries are rare but serious clinical situations. Their etiologies vary from missed injuries, delayed presentation for treatment, and wrong initial management. The clinical symptoms include spinal and/or radicular pain, scoliotic and/or kyphotic deformity, and neurological deficits. Management of these neglected injuries is difficult with respect to intraoperative difficulties, higher incidence of surgical complications, and subsequent rehabilitation.