Radiology Review

The Deer Stand Strikes Back

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The Deer Stand Strikes Back image

A 45-year-old man presents to your facility for evaluation of ongoing back pain. He reports that he fell out of a deer stand from an approximate height of 15 to 20 ft. He landed on his back but was able to get up, walk a short distance to his car, and drive home. Persistent pain is what brings him to the emergency department to seek treatment.

He denies any weakness or numbness in his lower extremities. There are no bowel or bladder issues. His medical history is unremarkable.

On physical examination, you note a moderately uncomfortable male whose vital signs are normal. He is able to move all four extremities well, and his strength is intact throughout. He does have moderate tenderness within the thoracolumbar region, with no step-off appreciated. The paraspinous muscles are tender as well.

You order lumbosacral radiographs (lateral view shown). What is your impression?


 

The Deer Stand Strikes Back image

ANSWER

The radiograph demonstrates a compression fracture of T12 with moderate loss of height approaching 50% anteriorly. In addition, there is a vertically oriented fracture within the middle of the vertebral body, causing the back portion to be posteriorly displaced.

This type of burst fracture is potentially unstable and should be treated as such. The patient was placed on strict spine precautions and transferred to a facility where trauma and neurosurgical services were available.

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