69 y.o. male presented in a wheelchair with back pain.  He had been standing on a scaffolding that began to rock backward and he slipped and fell onto an asphalt surface, about 5 or 6 feet by his estimation.  He immediately had severe low back pain, but no other complaints of pain.  He was able to stand and move to a truck, by which he was taken our clinic.

At that point, Emily wisely placed the patient supine on a cart in the procedure room, and I saw the patient. He remained at all points thereafter.  He stated he felt like he landed directly on his back, but conceded he may have landed on some part of his lower extremities or buttocks first.

ROS was negative for LOC, neck pain, chest or abdominal pain, lower extremity pain, paresthesias, or weakness; and no radiation of pain. No loss of bowel or bladder function. On exam (log-rolling the patient), he had essentially no lumbar tenderness or deformity, and no visible swelling or ecchymosis.  There was no pain or laxity with iliac compression. He was able to move all joints from hip to ankles without pain or limitation, and there were no areas of lower extremity tenderness, including his heels. DTRs were normal and symmetric, and sensation was intact to light touch throughout. An xray of the lumbar spine is attached for your review. 

Back Pain

There is the obvious compression fx of L2, but with retrropulsion of the posterior wall of the vertebra into the spinal canal.  He was transported on backboard by ambulance to the Hendricks ED where CT and MRI of the spine revealed a comminuted, unstable fracture of L2 extending into the posterior elements to the base of the spinous process and though the lamina.  The superior posterior vertebral body was retropulsed into the spinal canal by about 10mm.  This resulted in spinal stenosis with compression of the cauda equina.  

The patient remained entirely neurologically intact.  He was admitted to a spine surgeon