Management of an unstable lumbar fracture with a laminar split

This is a case report describing the injury sustained by a 36-year-old man injured in a motorcycle crash who sustained a fracture-dislocation of L2 up on L3, associated with a split in the lamina of L3. His neurologic lesion w as T12 ASIA B: with a motor score of 52 but with preservation of sensory fu nction (sensory score 96) in most parts of his lower extremities. He also s uffered a lower extremity fracture. Imaging of the spine is presented showi ng a multiplanar fracture associated with translation and with a defect in the lamina that may be seen in certain AO type B or type C fractures, that may entrap the lumbar spinal nerve roots. Discussants of this case comment on the classification and clinical significance of this fracture pattern, a nd present their operative approaches, both for management of this particul ar fracture pattern and for any associated dural tear. The issues of steroi d use and the place of rehabilitation are also discussed.