Late Onset of Neurogenic Complications in Single Neglected Unstable L2 A4/AO Type Fracture: Two Case Reports and Review of the Literature

Abstract

Introduction: Late-onset neurological impairment in unstable A3-A4/AO type thoracolumbar spinal fractures are rare, particularly if they are misdiagnosed as stable (25%). We present two neglected unstable burst fractures, who presented delayed trauma with neurologic deficit.
Case Presentation: Case 1: A 62-year-old male, who sought our department three months after trauma claiming neurogenic claudication, following fracture of L2.Case 2: A 50-year old male, who had a jerky fall from his vehicle with subsequent back pain for a few days. One-month after the trauma he presented urinary retention.
Conclusions: Unstable thoracolumbar A4 /AO type fractures, if left untreated or misdiagnosed, lead to vertebral body fragments retropulsed to the spinal canal under axial and bending forces resulting in progressively increased encroachment of the canal and finally compression on to cauda equina. Early recognition of an unstable A3-A4 /AO-type thoracolumbar fracture with C/T scan is mandatory along with appropriate treatment. This should be done in all cases, even in these without any neurological deficit and these with "normal" plain X-rays, because misdiagnosis and late onset neurological deficit is always a possibility. Physicians should be aware of this complication when treating thoracolumbar spine injuries with minor or absent symptoms and physiological neurologic findings.