Muhamad Na'im B Ab Razak (jacknaim) is a fresh graduate Muslim Doctor from Universiti Sains Malaysia and waiting for the enrollment into the housemanship program. Ambitious in pursuing master program in emergency and traumatology medicine and loves to spent his free time joining humanitarian missions, writing and speaks as an amateur public speaker in motivation and comparative religion. [HOME]

Patient with low back pain and lower limb numbness

Answer

1) plain radiograph shows

- This is a lateral lumbosarcral view
- There is a compression fracture of the L4 with loss of ½ of the vertebral body
- No lytic or sclerotic lesion seen on the spine.

2) Mechanism of injury

- In osteoporotic patient who slip and land on their bottom
- Young patient who fall from height and land on their heels (look at the calcaneal to see fracture)
- Pilot who eject from jet aircraft due to upward force of the rockets in the ejector seat crush the vertebra.
- Fracture in TB spine due to collapse of the vertebra.


3) Question to ask or info to obtain

- Age and gender of the patient
- Other fracture like distal radius or neck of femur (osteoporosis)
- History of fall on the buttock
- Fall from height and land on heels
- Any contact with TB patient


4) Deformity can be accepted and no need treatment unless more than 50% collapse of vertebra body (distraction and internal fixation may be needed)

+ Analgesic depending on patient requirement. May give simple analgesic such as NSAIDs (ibuprofen, mefenamic acid, diclofenac acid) but some patient may require opioid if there is co-existing nerve compression or slipped disc.

Bed rest

Neurological evaluation. If abnormal, patient may require MRI of the spine to confirm the pathology