A 27-year-old man presented with severe back pain after falling 20 feet from a ladder. He was neurologically intact. An axial computed tomographic image showed an LI flexion/compression fracture of the vertebral body with approximately 50% spinal canal compromise (Fig. 1).Although the patient was neurologically intact, he had an LI vertebral body fracture after axial loading involving the anterior and middle columns (1). Failure of the middle column has been shown to correlate significantly with biomechanical instability in thoracolumbar flexion/compression fractures (2).
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