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Back Pain After Work Accident


Consult Page

38M pw severe pain with severe trauma to the back

Initial Imaging

Figure 8.1, Sagittal CT of the thoracic spine without contrast demonstrates (A) fracture-dislocation involving all 3 columns of T11-T12 with a teardrop fracture of T12, disruption of the supero-anterior endplate of the T12 vertebral body, posterior displacement of the T12 vertebral body, markedly enlarged T11-T12 interspinous process distance, and (B) bilateral perched facets. The findings are consistent with an unstable flexion-distraction injury, or soft-tissue Chance fracture.

Figure 8.2, STIR MRI of the thoracic spine (A) demonstrates disruption of the anterior and posterior longitudinal ligaments (yellow arrow) as well as the posterior ligamentous complex (asterisk). Axial T2-weighted MRI at the level of T12 (B) shows moderate spinal canal stenosis.

Walking Thoughts

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    What was the mechanism of injury? Was it witnessed?

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    What treatments have been given en route to the hospital?

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    Has the patient been evaluated by the trauma team?

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    What other injuries does he have, and which is the most critical? Is he hemodynamically stable?

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    Any concern for intracranial or cervical/lumbar spine injury? What is his current clinical and neurological status?

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    Is he on any anticoagulants or antiplatelet agents?

History of Present Illness

A 37 year old male construction worker with no significant medical history presents with severe mid- and low-back pain after an accident at work an hour ago. A 7000 pound excavator tipped over, hit him across the neck, pushed him into a 3 feet ditch, and pinned him to the ground in a flexed position. He was extracted by emergency medical services and brought to the emergency department. He denies loss of consciousness. He was unable to move his legs for several minutes before regaining full strength. Currently, he has a 10 out of 10 burning, throbbing pain originating from the mid- and low-back that wraps around to the front. He denies leg pain, paresthesias, weakness, bowel or bladder incontinence, or saddle anesthesia. He is not on any anticoagulant or antiplatelet medications. His last oral intake is a glass of water 8 hours ago.

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