Lag screw fixation of remote bilateral pedicle fractures of the fourth and fifth lumbar vertebrae after a single gunshot wound: a case report and technical pearl

Abstract Background context Of the injuries involving the lumbar spine, pedicle fractures are among the least common; those involving bilateral pedicles are rare. Purpose The aims of the study were to provide the first documentation of bilateral pedicle fractures at two consecutive levels after a gunshot, to review the mechanism of injury, and to evaluate a nonfusion treatment option for pedicle fractures. Study design This is a technical note and case report. Outcome measure The outcome measures were lumbar range of motion, return of motor and sensory functions, and return to normal activities. Methods A 20-year-old male sustained bilateral pedicle fractures at L4 and L5 with a massive dural tear, progressive neurologic deficits, and urinary incontinence. He underwent repair of the dural tear and lag screw fixation of the pedicle fractures without fusion. Results The patient had full range of motion of his lumbar spine, full strength in his lower extremities, and bladder control. Conclusions This is the first report of bilateral multilevel lumbar pedicle fractures after a single penetrating gunshot wound. The case documents this injury pattern after a gunshot, reviews the mechanism of injury, and presents the successful application of a nonfusion treatment option.