title: An L-2 burst fracture and cauda equina syndrome due to tetanus.
abstract: Thoracic vertebral compression fractures are a known complication of generalized tetanus. The authors report the first known case of an L-2 burst fracture leading to cauda equina syndrome, as a result of generalized tetanus.   This 51-year-old man had generalized tetanus with a constellation of symptoms including compartment syndrome requiring fasciotomies, severe axial spasms and spasms of the extremities, autonomic dysreflexia, hypercarbic respiratory failure, and rhabdomyolysis. During the course of his illness, areflexic paraparesis developed in his lower extremities. He was found to have an L-2 burst fracture with retropulsion of a bone fragment resulting in cauda equina syndrome. Operative intervention was undertaken to decompress the cauda equina and stabilize the spine.   The natural progression of tetanus can be complex, with a mixed picture ranging from spasms plus increased tone and reflexes to reduced tone and reflexes as presynaptic nerve terminals become damaged. The authors suggest that all sudden changes in the neurological examination should prompt consideration of diagnostic imaging before attributing such changes to natural progression of the disease.
authors.affiliation: Department of Neurosurgery, University of Michigan Health System, Ann Arbor, Michigan 48109-5338, USA.
authors.forename: Thomas J
authors.initials: TJ
authors.lastname: Wilson
authors.forename: Daniel A
authors.initials: DA
authors.lastname: Orringer
authors.forename: Stephen E
authors.initials: SE
authors.lastname: Sullivan
authors.forename: Parag G
authors.initials: PG
authors.lastname: Patil
mesh_terms: D050815:Fractures, Compression / Q000209:etiology* / Q000601:surgery; D006801:Humans; D008159:Lumbar Vertebrae / Q000293:injuries* / Q000601:surgery; D008297:Male; D008875:Middle Aged; D011128:Polyradiculopathy / Q000209:etiology* / Q000601:surgery; D016103:Spinal Fractures / Q000209:etiology* / Q000601:surgery; D013742:Tetanus / Q000150:complications* / Q000601:surgery