Fig. 4.

Fifty-year-old woman with flexion-distraction injury at L4 due to motor vehicle collision. Injury was 3-column by Denis classification, with posterior element fractures present in addition to burst morphology, and A4B2 in AO classification. There was mild comminution and moderate spreading of the fragments (3 points in the load sharing classification). Initial MRI interpretation at time of injury was partial injury of PLC (TLICS 4) but retrospective interpretation was complete PLC injury (TLICS 5). Neurologic status was normal. A. Sagittal STIR MRI Initial MRI was interpreted at time of injury as partial PLC injury. On retrospective review, it was felt to be completely disrupted. Solid arrow points to ligamentum flavum, arrowhead to interspinous ligament, and open arrow to supraspinous ligament. The patient did not undergo surgical fixation. Lordosis from L3 to L5 measured 36°.B. Axial T2 WI 13 months after injury shows widened facet joints (arrows), which were not present on initial MRI. C. Lateral radiographs 13 months after injury show healed fracture, with loss of vertebral body height. Lordosis measured 10°, representing a 25° decrease from the original MRI. The patient complained of chronic back pain.