Chance-Type Fracture of L1 with Entrapment of the Cauda Equina

Abstract

A patient is presented who sustained a motor vehicle accident while wearing a seat belt. Due to life-threatening intraabdominal lesions, a Chance-type fracture of L1 and a subluxation of C6/C7 were diagnosed and treated surgically with a certain delay. The retention of urine and fecal incontinence could be explained as being due to a partial entrapment of the cauda equina at the level of the fractured pedicle of L1 on the right side with an associated injury of the conus medullaris. IntroductionThe Chance-type fracture, also known as seat-belt injury or transverse bicolumn fracture [1], remains an uncommon injury to the thoracolumbar spine [2][3][4][5][6][7]. A combination of a Chance-type fracture and an injury to the cervical spine is even more uncommon [8]. Although neurologic deficits are rare [1], other associated injuries are frequently reported.We present a seat-belt injury with life-threatening intraabdominal lesions. Furthermore, there was a Chance-type fracture of L1 (type C2.2.1) in combination with an injury to the cervical spine. The urinary problems and fecal incontinence observed could be due to an entrapment of the cauda equina at the fractured pedicle of L1 on the right side together with a compression of the conus medullaris.