A Novel Case of Multi-Level Lumbar Spine Injury

Abstract

Background: Fractures involving several posterior arch elements of lumbar vertebrae are rare and usually associated with high- energy axial loading (e.g., burst fracture) or hyperflexion and distraction (e.g., Chance fracture) resulting in displacement and neurological sequelae. This report explains the mechanical and biomechanical factors and treatment options for a novel fracture pattern involving multi-level posterior arch vertebral fractures and imparts optimism for timely recovery and return to play in high-level athletes.

Case Report: We report a case of a 21-year-old male elite football player with an acute, traumatic two-level lumbar pedicle, pars, and lamina fractures without failure of the vertebral body nor neurological complications. Treatment was conservative with relative rest, movement restrictions, non-narcotic analgesics, and a bone growth stimulator. After four months, the patient was pain-free with corresponding radiographic evidence of healing. He returned to training with special attention given to core strength and lumbopelvic mobility. A computed tomography (CT) scan 2.5 years after the injury showed no evidence of pars, lamina, or pedicle fractures. To date, this patient has played in the National Football League (NFL) as a starter for three years without any complaint of low back pain.

Conclusion: This unique fracture pattern could represent a harbinger to a more severe injury. We discuss mechanical and biomechanical factors, management, and return to play expectations for a collision sport athlete with this particular spine injury.