title: Pure hyperextension injury of the lower lumbar spine with an ureteral impingement.
abstract: BACKGROUND
  Pure hyperextension thoracolumbar spinal fractures are unusual and occur primarily in patients with ankylosing spondylitis and diffuse idiopathic skeletal hyperostosis due to the rigidity of the spine.
  
  
  METHODS
  A 62-year-old female with osteoporosis presented with a significantly displaced fourth vertebral body fracture after being hit by a motorcycle. An imaging study showed widening of the vertebral height of L4 anteriorly with a horizontal fracture extending across the vertebral body. An in situ instrumented lumbar fusion from the second to fifth lumbar vertebrae was performed. Postoperatively, the patient complained of abdominal pain and difficulty in voiding. Computed tomography and intravenous pyelography showed that the right ureter was impinged between the fractured gaps of the vertebral body of L4.
  
  
  RESULTS
  Solid bony union was obtained with surgical intervention.
  
  
  CONCLUSIONS
  This case reports a rare distractive extension injury in the lower lumbar spine with ureteral impingement. One should be aware of possible complications such as ureteral impingement following a pure hyperextension injury in the lower lumbar spine.
authors: Department of Orthopaedic Surgery, College of Medicine, Incheon St. Mary's Hospital, The Catholic University of Korea, Seoul, Korea.
authors: In-Soo
authors: IS
authors: Oh
authors: Dong-Gune
authors: DG
authors: Chang
authors: Young-Hoon
authors: YH
authors: Kim
authors: Kee-Yong
authors: KY
authors: Ha
mesh_terms: D000063:Accidents, Traffic; D005260:Female; D006801:Humans; D008159:Lumbar Vertebrae / Q000293:injuries* / Q000601:surgery; D008875:Middle Aged; D016103:Spinal Fractures / Q000150:complications* / Q000473:pathology / Q000601:surgery; D013123:Spinal Fusion; D014513:Ureter / Q000293:injuries*