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Spine Case 1 ED Management

L2 Burst Fracture

ED Management

Because the mechanism of injury is usually severe, a full trauma evaluation is indicated.

Emergent consultation from a spine specialist is indicated. Intravenous methylprednisolone (given as bolus of 30 mg/kg, followed by infusion at 5.4 mg/kg/hour for 23 hours) is used in some institutions for blunt spinal cord injuries. If used, it should be started within eight hours of injury, in consultation with the spine specialist. The specialist will make further management decisions regarding possible surgical stabilization.

Burst fractures are unstable when there is:

  1. neurologic deficit
  2. >50% loss of vertebral body height
  3. >30% of canal compromise
  4. >20º angulation at the thoracolumbar junction.