title: Seizure-induced lumbar burst fracture.
abstract: METHODS
  This case report illustrates how muscle forces generated during generalized seizure activity can result in severe musculoskeletal trauma. A case is presented of a 35-year-old man who suffered seizure-induced contiguous L1 and L2 lumbar burst fractures.
  
  
  BACKGROUND
  To the authors' knowledge, there have been no reports of seizure-associated lumbar burst fractures.
  
  
  OBJECTIVE
  The case is presented to demonstrate how seizure activity can lead to lumbar burst fractures.
  
  
  METHODS
  A 35-year-old man suffered a witnessed tonic-clonic seizure while lying on a couch. He had no other trauma and no history of previous seizure activity. As his mental status cleared in the post-ictal period, he complained of mild low back pain. Upon ambulation, he continued to complain of persistent low back pain. Plain radiographs obtained on hospital visit day 5 identified the L1 and L2 contiguous burst fractures. Initial treatment using a Risser cast was unsuccessful, and the patient subsequently underwent posterior spine fusion with Cotrel-Dubousset segmental instrumentation and an iliac crest bone graft.
  
  
  RESULTS
  At 1-year follow-up, the patient's spine was stable with no evidence of pseudoarthrosis or further kyphosis. He was maintained on anti-seizure medication.
  
  
  CONCLUSIONS
  Forces generated during a tonic-clonic seizure can result in axial skeletal trauma, including thoracic and lumbar burst fractures. Clinical signs of unstable fractures may be subtle. A high index of clinical suspicion is warranted for patients who experience tonic-clonic seizures and who have associated risk factors.
authors.affiliation: Department of Surgery, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire, USA.
authors.forename: J A
authors.initials: JA
authors.lastname: Youssef
authors.forename: G M
authors.initials: GM
authors.lastname: McCullen
authors.forename: C C
authors.initials: CC
authors.lastname: Brown
mesh_terms: D000328:Adult; D006801:Humans; D008159:Lumbar Vertebrae / Q000293:injuries* / Q000601:surgery; D008297:Male; D012640:Seizures / Q000150:complications*; D016103:Spinal Fractures / Q000209:etiology* / Q000601:surgery; D013123:Spinal Fusion