Case 3

Patient: 26-year-old man.

Incident: While riding an MPWC, with a friend doubling, he attempted to jump a wave. His machine caught the crest and threw him higher than anticipated and at an awkward angle. He jumped off and landed on his back in the water. He was wearing a personal flotation device.

Injuries: Immediate pain felt in the back and inability to move either leg; flaccid paralysis from L3 myotome and incomplete sensory loss from L3 dermatome.

Investigations: Plain x-rays of the lumbar spine showed a burst fracture of L1, with splaying of the pedicles and a retropulsed fragment. Computed tomography scan at RNSH also showed a burst fracture of L1 as well as fractures of L1 and L2 transverse processes, and fractures through the left pedicle of L1 and of the inferior end plates of T12 and L2.

Management: L1 vertebrectomy and decompression and spinal fusion.

Outcome: After 48 days in RNSH, he was transferred to a rehabilitation hospital, where he remains. He has regained some movement in his lower limbs and is expected to continue to improve.