Delayed Neurological Deficits Following Lumbar 1 Burst Fracture: A Diagnostic Challenge Without Radiological Correlates

This case report discusses a patient who experienced a spinal fracture and initially had no nerve damage, but later developed weakness and other neurological issues. Despite advanced imaging, no clear cause for the delayed nerve problems was found. The delayed onset of neurological problems after a spinal injury, without a clear cause on imaging, is difficult to classify using current medical terms. This makes diagnosis and treatment planning challenging. The authors suggest that the existing classification system for spinal cord injuries needs to be updated to include cases with delayed neurological symptoms that don't fit neatly into existing categories like SCIWORA (spinal cord injury without radiographic abnormality).

• 1
  A 55-year-old man with a stable L1 burst fracture developed delayed neurological deficits two weeks after sustaining a fall, despite no evidence of intrinsic or extrinsic spinal cord abnormalities on MRI.
• 2
  Follow-up investigations, including MRI, electromyography, nerve conduction studies, and blood tests, were unremarkable, indicating a clinicoradiologic mismatch.
• 3
  The delayed onset of symptoms and structural abnormalities in this case fell outside traditional SCIWORA criteria, highlighting a gap in current terminology.