J A Youssef1, G M McCullen, C C Brown. 1. Department of Surgery, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire, USA.
Abstract
STUDY DESIGN: This case report illustrates how muscle forces generated during generalized seizure activity can result 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 DATA: To the authors' knowledge, there have been no reports of seizure-associated lumbar burst fractures. OBJECTIVE: The case is presented to demonstrate how seizure activity can lead to lumbar burst fractures. METHODS: A 35-year-old man suffered a witnessed tonic-clonic seizure while lying on a couch. He had no other trauma and no history of previous seizure activity. As his mental status cleared in the post-ictal period, he complained of mild low back pain. Upon ambulation, he continued to complain of persistent low back pain. Plain radiographs obtained on hospital visit day 5 identified the L1 and L2 contiguous burst fractures. Initial treatment using a Risser cast was unsuccessful, and the patient subsequently underwent posterior spine fusion with Cotrel-Dubousset 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-seizure medication. CONCLUSIONS: Forces generated during a tonic-clonic seizure can result in axial skeletal trauma, including thoracic and lumbar burst fractures. Clinical signs of unstable fractures may be subtle. A high index of clinical suspicion is warranted for patients who experience tonic-clonic seizures and who have associated risk factors.
STUDY DESIGN: This case report illustrates how muscle forces generated during generalized seizure activity can result 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 DATA: To the authors' knowledge, there have been no reports of seizure-associated lumbar burst fractures. OBJECTIVE: The case is presented to demonstrate how seizure activity can lead to lumbar burst fractures. METHODS: A 35-year-old man suffered a witnessed tonic-clonic seizure while lying on a couch. He had no other trauma and no history of previous seizure activity. As his mental status cleared in the post-ictal period, he complained of mild low back pain. Upon ambulation, he continued to complain of persistent low back pain. Plain radiographs obtained on hospital visit day 5 identified the L1 and L2 contiguous burst fractures. Initial treatment using a Risser cast was unsuccessful, and the patient subsequently underwent posterior spine fusion with Cotrel-Dubousset 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-seizure medication. CONCLUSIONS: Forces generated during a tonic-clonic seizure can result in axial skeletal trauma, including thoracic and lumbar burst fractures. Clinical signs of unstable fractures may be subtle. A high index of clinical suspicion is warranted for patients who experience tonic-clonic seizures and who have associated risk factors.
Authors: Winston W Yen; Nouraiz Falik; Lara G Passfall; Oscar Krol; Thomas E Sanchez; Gregory S Penny; Bradley C Wham; Nishant Suneja Journal: J Orthop Date: 2021-05-07