Figure 2

Second illustrative case of TLISS use. Patient is a 21 y/o male who presents after a motor vehicle accident. The patient was neurologically intact. Representative sagittal (A) and axial (B) computed tomography and sagittal T2-weighted magnetic resonance images (C) were obtained. A compression fracture with compromise of the superior endplate of L1 is found. Nondisplaced laminar fractures were present in the posterior elements bilaterally (Figure 2 A, white arrow). MRI imaging showed increased signal in the interspinous space, possibly indicating ligamentous injury and confirming involvement of posterior spinal elements. The patient receives one point for the compression fracture and an additional point for burst characteristics (posterior bony fractures). MRI suggests posterior ligamentous disruption (2 points). The patient was neurologically intact (0 points). The comprehensive score of 4 suggests either operative therapy or external orthosis may be used. We chose conservative treatment in this case.