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Case library  /  C-05  ·  TRAUMA

L1 fracture from a fall — fusion with cage

32-year-old scaffolding construction worker, fall from height. Severe low back pain and weakness — CT shows an L1 fracture with bone pushed into the canal.

BeforeAfter
Before treatment — de-identified imaging After treatment — de-identified imaging
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The films
Pre-op sagittal CT — L1 fracture — de-identified
Pre-op sagittal CT — L1 fracture
Axial CT — intact level for comparison — de-identified
Axial CT — intact level for comparison
Axial CT — fracture with canal compromise (arrow) — de-identified
Axial CT — fracture with canal compromise (arrow)
Post-op standing lateral — fusion with cage — de-identified
Post-op standing lateral — fusion with cage
Post-op standing AP — de-identified
Post-op standing AP
Where in the spine

The junction level that takes the hit.

L1 sits at the thoracolumbar junction — where the stiff, rib-anchored thoracic spine meets the mobile lumbar spine. In falls from height that transition concentrates the force, which is why burst fractures cluster here.

The fractured vertebra was rebuilt with a cage and braced by screws in the levels above and below.

L1 burst fracture — rebuilt with cage
Instrumented above and below
The course, in order
  1. Day 0Fall from heightScaffolding job. CT: L1 fracture with bone pushed into the canal.
  2. The decisionA surgical injuryUnstable fracture plus weakness in a young laborer: stabilize it, protect the nerves.
  3. SurgeryFusion with cageThe fractured level rebuilt and braced above and below.
  4. Months 1–9Staged returnProgressive therapy with staged weight restrictions.
  5. ~9 monthsMMIPossible permanent lifting restrictions — planned honestly from day one.
Presentation
Fall from height on a scaffolding job; severe low back pain and weakness, on top of prior deformity-correction surgery.
Imaging
CT shows the L1 fracture — the axial cut with the arrow shows fractured bone crowding the spinal canal.
Decision
An unstable fracture with weakness in a young laborer is a surgical injury: stabilize it, protect the nerves, and plan the return to heavy work honestly from day one.
What was done
Lumbar fusion with cage reconstruction of the fractured level, then progressive therapy with staged weight restrictions.
Expected MMI ~9 monthsProgressive PT & weight limitsPossible permanent lifting restrictions
"In workers' comp trauma, honest timelines are part of the treatment."
All cases shown are real patients treated by Dr. Andrew Pugely, presented with de-identified imaging for education. Every spine — and every recovery — is different: individual results vary, and nothing on this page is a guarantee of outcome or a substitute for an in-person evaluation.
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