J Korean Soc Spine Surg.  2019 Dec;26(4):166-171. 10.4184/jkss.2019.26.4.166.

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

Affiliations
  • 1Department of Orthopedic Surgery, Inje University Seoul Paik Hospital, Seoul, Korea. hd1404@hanafos.com

Abstract

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 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.

Keyword

Baastrup's disease; Kissing spine; Three-column fracture; Posterior fusion

MeSH Terms

Accidental Falls
Aged
Aged, 80 and over
Back Pain
Braces
Female
Follow-Up Studies
Humans
Lower Extremity
Spinal Fractures
Spine

Figure

  • Fig. 1. (A) Initial radiographs showing severe narrowing of the interspi-nous process (red arrows). (B) Three-dimensional reconstruction of computed tomography images showing Baastrup disease (kissing spine).

  • Fig. 2. Serial sagittal computed tomography images showing the 3-col-umn fracture with (A) posterior vertebral wall bulging (red arrow), (B) a displaced posterior column fracture, and (C) a collapsing vertebral body.

  • Fig. 3. Magnetic resonance imaging scan showing a mild cord-compressing lesion with buckling of the ligamentum flavum.

  • Fig. 4. Progression of the canal-compromising lesion on follow-up (A) sagittal and (B) axial computed tomography images.

  • Fig. 5. (A) Simple radiograph after posterior fusion at the T9-10-12-L1 levels. (B) Restored height of the T11 vertebral body on a lateral view (red box).


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