An MRI scan demonstrated discogenic deterioration at L5/S1 with a central disc bulge and reduced space for nerves (as per image left).

Non-operative measures including rest, analgesic medication, physiotherapy, facet joint injections and an epidural injection were used to initially treat the pain but the symptoms failed to respond.

A L5/S1 discogram (injection into the disc) verified the disc as the source of pain generation.

Surgery was performed involving an anterior lumbar interbody fusion. This resolved the patient’s symptoms and allowed her to return to her pre-injury activities without restriction.

The diagnosis was of a delayed presentation of a complex neck fracture (bilateral cervical fracture / dislocation with neurologic deterioration), as shown in the image, left.

This was treated surgically to restore spinal alignment and space for nerves.

The surgery involved separate posterior (back of neck) and anterior (front of neck) approaches to reduce the dislocation and fix the fracture with rods, screws, local pelvic bone graft and a plate, as shown in the second image, left below.

The patient has recovered fully from the surgery with resolution of neck pain and the arm symptoms.

He will be able to return to all activities he enjoys though I have recommended against a return to contact sports.

(A recently well documented similar injury was suffered by a NRL player.)