Unstable Spinal Fracture And Spinal Cord Injury: Horse-drawn Chariot Racing

HISTORY: Our case report describes a 38 year old male with no significant past medical history who presented to the emergency department with neck pain after being thrown off from a horse-drawn chariot during racing. PHYSICAL EXAMINATION: Tenderness along entire spinal column and chest, initially neurologically intact and mentating well DIFFERENTIAL DIAGNOSIS: Spinal fracture, rib fractures, pneumothorax TEST AND RESULTS: Imaging was notable for a right midclavicular fracture, right first and second rib fractures, left first rib fractures, a small right apical pneumothorax, and a right 5th metacarpal fracture. Spinal imaging was notable for acute compression fracture of T12 vertebral body extending in to the pedicles, bilateral facet joints, and the spinous processes. Acute right T11, bilateral T12, right L1, L2 right transverse process fractures, right L1 spinous process fracture. FINAL WORKING DIAGNOSIS: Unstable T12 burst fracture, with clinical conus medullaris injury (bladder dysfunction). TREATMENT AND OUTCOMES: Orthopedic and trauma surgery were consulted for the unstable three column T12 vertebral body fracture. The patient was transferred to the surgical intensive care unit (ICU) in the setting of new onset urinary retention and unstable spinal fractures concerning for spinal shock. MRI demonstrated spinal cord edema at T12-L1. The patient was taken emergently to the operating room for an unstable T12 flexion and distraction injury, with clinical conus medullaris injury (bladder dysfunction). Underwent posterior thoracic and lumbar fusion from levels T10-L2. initiated on physical and occupational therapy programs and progressed successfully. The patient passed a trial of void and the foley was removed. The patient was cleared for discharge two weeks from initial injury.