Clearly there are compression fractures of the L2 and L3 superior endplates. The sclerotic lines in the upper portion of the vertebral bodies are due to compressed bone. The upper part of the posterior cortices is also buckled to the spinal canal. If you want to use the Thoraco-Lumbar Injury Classification and Severity (TLICS) terminology, you may call the morphology of this fracture as “burst” but there are more findings to consider. In particular, the interspinous distance at L1-L2 appears increased compared to the remaining interspinous distances, a finding that should raise suspicious (but is not definitive for) injury to the posterior ligamentous complex.

A

B

Image A (Sagittal image through patient’s right) shows a horizontally oriented fracture through the posterior elements at L2 on the right side. Image B on the other hand shows fractures of the left superior articular process of L2 with mild widening of the left L1-L2 facet joint compared to the right. Based on these additional fracture, one can make the case that the fracture is best described as a distraction pattern or “Chance” fracture. Regardless, these additional fractures make an injury to the posterior ligamentous complex much more likely and so an MRI is warranted to assess the ligaments.

The L2 left transverse process is also fractured but it’s not of much concern!