Clinical Presentation & Protocol
Patient Usually Complains Of
Patient presents following high-energy trauma with acute onset of severe localized mid-lumbar back pain. Pain is exacerbated by movement, weight-bearing, and axial loading. No reported bowel or bladder incontinence, saddle anesthesia, or progressive lower extremity weakness. Mechanism of injury consistent with axial compression.
Clinical Examination Findings
Spinal examination reveals midline tenderness at the L2 level with associated paravertebral muscle spasm. Neurological exam: Motor strength 5/5 in bilateral lower extremities; sensation intact to light touch and pinprick in all dermatomes; deep tendon reflexes 2+ and symmetric; no pathological reflexes (Babinski/Clonus). Gait deferred due to pain.
Treatment Protocol
Immobilization with a rigid thoracolumbar orthosis (TLSO). Strict activity modification: no lifting >5 lbs, no bending, lifting, or twisting (BLT). Pain management with scheduled NSAIDs and muscle relaxants. Urgent neurosurgical consultation for assessment of burst fracture stability and potential need for surgical stabilization (kyphoplasty/fixation).