The patient was admitted to Shmaisani hospital 16-August-2011 after falling from 5 meters height without loss of consciousness and with severe LBP and weak left lower limb with numbness left foot.

MRI lumbar spine done 16-August-2011  and CT-scan with LSS X-rays confirmed the presence of burst fracture L1 with bony compression.

On examination: the patient in bed with agonizing back pain and weak dorsi and planterflexion left foot 3/5 with numbness and analgesia at left L5 and S1 territories. There is Foley's catheter.

The patient was put under observation for major vital signs for 24 hours.

Skeletonization of D12, L1 and 2 down to the transverse processii. The intraspinous ligament is ruptured at D12-L1 level. Using Depuy Spine Expedium polyaxial transpedicular screws - 2 screws were inserted to L2 body right 6x45 mm and left 6x40 mm . 2 screws were inserted to D12 body 5x40 mm. Distraction-reduction was done from the right. Good reduction of the body of L1 was achieved. Overdistraction from the left side resulted in slippage of the left screw at D12 body. The screw was removed and another polyaxial 5x45 mm screw was inserted. The distraction was applied down to the left L2 transpedicular screw. The Cross Link was applied and BoneSave 40 gm was delivered to the body of L1 through transpedicular route left side.  All stages of surgery were under C-arm control. The construct was checked with forced traction to all units.

Routine closure of the wound.  Smooth postoperative recovery  with improvement of the power of the left foot..

The fracture not only unstable, but also compressing the neural elements.

Distraction-reduction of the deformed L1 was achieved in excellent fashion through ligamentotaxis.

The slippage of the upper left screw was due to overdistraction. It was replaced with another more wide and longer screw.