Lumbar facet fracture in an adolescent ice hockey player

A 14-year-old boy was checked hard as he was winding up to shoot in an ice hockey game. He experienced low-back pain during the game but when examined later for complaints of pain and fever, he denied trauma. Plain x-rays were normal, but a bone scan showed increased uptake at L-3. MRI evaluation revealed a lumbar mass; a CT scan showed the mass to be a hematoma and edema secondary to a facet fracture. Acute severe back pain in a hockey player should prompt a careful history and a search for musculoskeletal injury. When trauma in the lumbar spine is suspected and plain radiographs are nondiagnostic, CT scans are more precise than MRI for diagnosing injury.