Three-Column Fracture in the Thoracolumbar Junction Caused by Low-Energy Trauma in a Patient with Baastrup Disease: A Case Report

In Keun Park, Jun-Ku Lee, Jung Gook Seo
2019 Journal of Korean Society of Spine Surgery  
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
more » ... el 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.
doi:10.4184/jkss.2019.26.4.166 fatcat:lhtw4jpzwrhxve6dg6b7vwhppa