L1 is the first lumbar vertebra at the thoracolumbar junction, the most common level for burst fractures from axial loading injury. The conus medullaris typically terminates at the L1-L2 level in adults. L1 has no costal facets and its transverse processes are vestigial costal elements (costal processes) rather than true transverse processes.
L1 burst fractures are the most common thoracolumbar fractures, occurring from axial load with flexion in falls from height and motor vehicle accidents. The thoracolumbar junction is biomechanically vulnerable due to the transition from the rigid thoracic cage to the mobile lumbar spine. Injury to the conus medullaris at L1 produces a mixed upper and lower motor neuron picture. Neurologically intact burst fractures with less than 50% canal compromise may be managed conservatively. Surgical stabilisation with pedicle screws spanning the fracture level restores alignment.
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