Epidural hematoma associated with L2 Chance fracture in a long lumbar posterior fused spine patient: A case report and literature review

Introduction: Several studies have reported that minor trauma could cause a fracture of the ankylosed spine, which easily becomes unstable due to the inflexibility of the fused spine and long lever arm. Delayed diagnosis of spinal epidural hematoma (SEH) may result in increased risk of neurological injury and poor prognosis. Purpose: To highlight the risk of lumbar spine Chance fracture associated with symptomatic SEH in a patient with long lumbar spine fusion (LSF). Methods: The clinical findings, radiographic appearance, and surgical treatment of a SEH associated with L2 Chance fracture in LSF are described. Results: A 55-year-old male patient, injured after falling from a 2.5 m tree, presented with severe back pain. On plain radiographs and computed tomography (CT) images, anterolateral osteophytes and fused lumbar vertebrae (L1－L5), in addition to an L2 Chance fracture, were noted. Patient was initially treated with bed rest followed by placement in a body cast due to improved clinical neurological deficits. Three days later, he presented with incomplete paraplegia of his lower limbs. Magnetic resonance imaging (MRI) images showed a SEH compressing the dura mater over L1－L3 area. The patient was successfully treated by L2 decompression and posterior fixation surgery using pedicle screws and rods over L1－L4. Postoperatively, there was rapid progressive improvement of motor and sensory function. Conclusions: A unique case of SEH complicating a L2 Chance fracture in LSH is presented. LSH is a risk factor for fracture and subsequent development of SEH. A high index of suspicion of SEH is necessary in such a case, particularly with early neurological deficits. Imaging studies including MRI and CT scans should be reviewed carefully to rule out any fracture or SEH.