Burst fracture of the first lumbar vertebra and conus-cauda syndrome complicating a single convulsive seizure: A challenge of diagnosis in the Emergency Department

Seizure induced lumbar burst fracture associated with conus medullaris-cauda equina compression

“…Kelly reported an incidence of seizure-induced fracture at 2.4%, but Finelli and Cardi reported an incidence as low as 0.3% (6,7). Most of these fractures occur at night and have a non traumatic etiology (1,3,4). In 60% of cases, patients remain asymptomatic due to a cloudy sensorium in the post-ictal phase (1, 4).…”

“…seizure-induced burst fracture of the spine is a rare clinical entity with only five cases reported in the medical literature to date (Table) (1)(2)(3)(4)(5). Although rare, it is extremely crucial to recognize this emergent fracture because it predisposes the patient to irreversible neurological injury (4).…”

“…Although rare, it is extremely crucial to recognize this emergent fracture because it predisposes the patient to irreversible neurological injury (4).…”

“…Following a seizure, the most common site of a compression vertebral fracture is the midthoracic spine, and the most common site of a burst vertebral fracture is the thoracolumbar junction of the spine (1,4,6). A burst fracture is more likely to cause neurological complications due to the fragmentation and comminution of the vertebral body, but a compression fracture remains asymptomatic in the majority of cases (7)(8)(9).…”

“…Such seizure episodes often occur due to electrolyte imbalance, drug overdose and/or drug withdrawal (1). Seizure-induced burst fracture of a vertebra is a nontraumatic fracture and may occur even at rest (1,4). One such case of a nocturnal double thoracic burst fracture has been reported in the literature by Rupprecht et al (3).…”