Seizure-Induced Thoracolumbar burst Fracture Secondary to Tramadol Abuse

Tramadol is a novel centrally acting opioid analgesic used for the treatment of mild to severe pain. This drug is the most prescribed opioid worldwide. It has been approved as an analgesic in Iran since 2002. Unfortunately Tramadol dependency has become very common in Iran in various age groups and genders but in particular is abused among the young generation. Overdose of Tramadol is a well-known cause of seizure. On the other hand, seizures regardless of etiology can induce fractures of the vertebral column by violent contractions of skeletal muscles. Seizure-induced vertebral fracture are mostly due to grand mal and are compression fractures located at mid thoracic region. Burst fractures of the spine secondary to seizure have rarely been reported in the literature. Herein, we describe a patient with thoracolumbar burst fracture secondary to violent contraction induced by sever seizure resulted from Tramadol overdose. This seems to be the first of such example in the literature. KEy worDS: Burst fracture, Cauda equina, Conus medullaris, Seizure, Tramadol A rahimizadeh et al. 51 World Spinal Column Journal, Volume 3 / No: 2 / May 2012 Figure 1: Plain radiograph showing T12 burst fracture; note associated osteopenia. Tramadol is a potent opioid drug introduced and approved in our country since 2002 and become the most prescribed opioid since then (19,20). In Iran, Tramadol has been reported to be increasingly abused by opioid dependent subjects. It seems that the higher prevalence of Tramadol abuse as tablets in our country may be because of less availability of other legal opioid such as Hydrocodone or Oxycodone and its availability in all Iranian private pharmacies (19,20). Overdose of this drug can cause seizure in one third of Tramadol abusers and this is supported by a number of papers (3,14). However, there is no report on vertebral column fracture secondary to Tramadol-induced seizure in the literature. Therefore a young abuser with severe witnessed convulsion resulting in thoracolumbar burst fracture is presented which is certainly the first example in the literature.