Three-Column Fracture in the Thoracolumbar Junction Caused by Low-Energy Trauma in a Patient with Baastrup Disease: A Case Report
10.4184/jkss.2019.26.4.166
- Author:
In Keun PARK
1
;
Jun Ku LEE
;
Jung Gook SEO
Author Information
1. Department of Orthopedic Surgery, Inje University Seoul Paik Hospital, Seoul, Korea. hd1404@hanafos.com
- Publication Type:Case Report
- Keywords:
Baastrup's disease;
Kissing spine;
Three-column fracture;
Posterior fusion
- MeSH:
Accidental Falls;
Aged;
Aged, 80 and over;
Back Pain;
Braces;
Female;
Follow-Up Studies;
Humans;
Lower Extremity;
Spinal Fractures;
Spine
- From:Journal of Korean Society of Spine Surgery
2019;26(4):166-171
- CountryRepublic of Korea
- Language:English
-
Abstract:
STUDY DESIGN: Case report.OBJECTIVES: We report a case of 3-column fracture caused by low-energy trauma in a patient with Baastrup disease who complained of acute radiating pain and motor weakness in the lower limbs after 3 weeks of conservative treatment. Subsequently, posterior fusion surgery was performed.SUMMARY OF LITERATURE REVIEW: Baastrup disease is characterized by enlargement and close approximation of adjacent spinous processes, and it mostly affects the L4-5 level of the spine. In patients with Baastrup disease affecting multiple levels of the lumbar spine, low-energy trauma can cause an unstable 3-column fracture with neurological compromise. Early recognition and surgical treatment prior to the emergence of a neurological deficit are required.MATERIALS AND METHODS: An 84-year-old woman presented with back pain after falling down backward and colliding with the edge of a shelf at ground level. Considering the patient's general condition and age, she was initially treated with close observation and placement of a spinal brace with serial radiographic follow-up.RESULTS: Computed tomography found 3-column fracture at the T11 level, which is quite rare in cases of minor trauma. At a 3-week follow-up, she complained of gradual lower extremity weakness, and her general lower extremity motor function decreased to grade 1–2. The patient underwent posterior fusion 2 levels above and below the affected vertebral body (T9-10-12-L1). Surgery was uneventful and the patient's motor function recovered.CONCLUSIONS: In patients with Baastrup disease affecting multiple levels of the lumbar spine, based on our experience, low-energy trauma can cause an unstable 3-column fracture with neurological compromise. We highly recommend scrutiny of the interspinous space in elderly patients, especially those with a spinal fracture caused by low-energy trauma.
