Delayed Diagnosis of a Flexion-Distraction (Seat Belt) Injury in a Patient With Multiple Abdominal Injuries: A Case Report

Abstract not available. Introduction provided instead.

Each year in the United States, more than 160,000 vertebral fractures occur, and more than 10,000 of these lead to spinal cord injury.¹ Roughly 50% of noncervical spinal cord injuries occur at the thoracolumbar junction.² Vertebral injuries can be masked in polytrauma patients secondary to overwhelming symptoms from concomitant injuries or in hemodynamically unstable patients who require emergent or urgent procedures before spinal assessment can be performed.³

In this report, we describe the clinical presentation, workup, and surgical management of a patient who was in a high-speed motor vehicle accident and received a delayed diagnosis of unstable thoracolumbar dislocation. Concomitant intra-abdominal injuries were the likely reason for initial masking of the spine lesion. Although these types of injuries are not rare, and missed injuries have been described in other reports, this case is unique in that the patient lacked signs or symptoms of spinal column injury at presentation. We hope to alert trauma practitioners to maintain a high index of suspicion for such injuries to avoid disastrous consequences.