Unusual burst fracture in an adolescent involving the apophyseal plate

A 12-year-old girl sustained an unusual burst-type fracture of her first lumbar vertebrae. The main fracture occurred through the anterior ring apophyses and the pedicle-body junction. The anterior ring apophyses were left close to their anatomic position. However, the whole vertebral body with minor internal fracturing was retropulsed into the spinal canal, resulting in incomplete paraplegia. Initial radiographs were complicated by a fracture-dislocation. However, a computed tomography scan elucidated the above-stated fracture pattern. This pattern has not been previously reported to our knowledge. Treatment consisted of intravenous steroids, anterior decompression, anterior fusion with instrumentation, and postoperative thoracolumbar-sacral orthosis. Neurologic improvement has occurred. The patient can now walk independently, but still has absent bladder/bowel function 3 months postoperatively.