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

Spinal cord injuries, including rare cases without radiological abnormalities, pose diagnostic challenges, particularly in cases of delayed neurological deficit development. This case report describes a 55-year-old man with a stable L1 burst fracture who developed delayed neurological deficits two weeks after sustaining a fall despite no evidence of intrinsic or extrinsic spinal cord abnormalities on magnetic resonance imaging (MRI). The patient initially presented with back pain, normal muscle strength across all myotomes, and imaging that showed no canal stenosis or retropulsion fragments. After symptom progression to bilateral lower limb weakness, urinary incontinence, and loss of anal tone, follow-up investigations, including MRI, electromyography, nerve conduction studies, and blood tests, were unremarkable. Although the clinical presentation appeared to indicate spinal cord injury without radiological abnormality (SCIWORA), the delayed onset of symptoms and structural abnormalities in this case fell outside traditional SCIWORA criteria. This case highlights a gap in the current terminology used to describe spinal cord injuries with delayed neurological presentation, emphasizing the need for more precise classification to inform diagnosis, management, and medicolegal documentation.