Radiology Review

Severe Pain Following Car Crash

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A 15-year-old girl is brought to your facility following a motor vehicle crash. She was a restrained back seat passenger in a vehicle that was struck from behind at a moderate rate of speed. Extensive damage to the vehicle was noted. The patient is complaining of severe abdominal and back pain. Medical history is unremarkable and vital signs are normal. Physical exam shows a female teen who is anxious but in no obvious distress. Her abdomen is firm, with diffuse tenderness and mild guarding. Palpation of her back reveals moderate tenderness in the lower lumbar spine. She is able to move all extremities well, with no other neurologic deficits noted. She is being sent for CT of the chest, abdomen, and pelvis; but first, a lateral radiograph of the lumbar spine is obtained (shown). What is your impression?


The radiograph shows malalignment at the L3-L4 level. There is a slight retrolisthesis, as well as widening of the interspinous disc space and the facets at this level. No compression fracture is seen.

Such findings are suggestive of a Chance fracture as a result of a hyperflexion injury. CT confirmed these findings. Such injuries are considered unstable and generally require surgical stabilization.

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