Early Return to Play Following Conservative Treatment of a Lumbar Flexion-Distraction Injury in a Professional Soccer Player: A Case Report

Flexion-distraction injuries of the thoracolumbar spine, often classified as AO type B2, are typically considered unstable and are generally managed surgically. However, the optimal approach for managing such injuries in elite athletes remains unclear, particularly considering the potential career-limiting consequences of spinal fusion. We report the case of a 32-year-old professional soccer player who sustained a flexion-distraction injury at the T12-L1 level during a match. Imaging confirmed an L1 compression fracture with posterior ligament complex disruption. Despite surgical indications, the athlete exhibited excellent core stability, no neurological deficits, and preserved alignment. A multidisciplinary team opted for conservative treatment, including rigid bracing and staged rehabilitation. The athlete resumed non-contact training at week seven, returned to full-contact practice at week 10, and competed in official matches by week 12. At the two-year follow-up, he remained symptom-free, with no spinal deformity or recurrence. This case suggests that in elite athletes with preserved spinal stability and core strength, conservative management of flexion-distraction injuries may allow for a timely return to play while avoiding the long-term drawbacks of fusion surgery. Individualized decision-making and close follow-ups are essential.