SEIZURE-INDUCED LUMBAR BURST FRACTURE

Study Design. This case report illustrates how muscle forces generated during generalized seizure activity in severe musculoskeletal trauma. A case is presented of a 35-year-old man who suffered seizure-induced contiguous L1 and L2 lumbar burst fractures. Summary of Background Da ta. To the authors' knowledge, there have been no reports of seizure-a ssociated lumbar burst fractures. Objective. the case is presented to demonstrate how seizure activity can lead to lumbar burst fractures. M ethods. A 35-year-old man suffered a witnessed tonic-clonic seizure wh ile lying on a couch. He had no other trauma and no history of previou s seizure activity. As his mental status cleared in the post-ictal per iod, he complained of mild low back pain. Upon ambulation, he continue d to complain of persistent low back pain. Plain radiographs obtained on hospital visit day 5 identified the L1 and L2 contiguous burst frac tures. Initial treatment using a Risser cast was unsuccessful, and the patient subsequently underwent posterior spine fusion with Cotrel-Dub ousset segmental instrumentation and an iliac crest bone graft.Results . At 1-year follow-up, the patient's spine was stable with no evidence of pseudoarthrosis or further kyphosis. He was maintained on anti-sei zure medication. Conclusions. Forces generated during a tonic-clonic s eizure can result in axial skeletal trauma, including thoracic and lum bar burst fractures. Clinical signs of unstable fractures may be subtl e. A high index of clinical suspicion is warranted for patients who ex perience tonic-clonic seizures and who have associated risk factors,