A 17-year-old adolescent girl with no past medical history presented to the emergency department with a chief complaint of lower back pain after sustaining a minor fall several hours earlier. Physical examination revealed mild to moderate back tenderness, and the result of review of systems was negative. Laboratory evaluation was within reference limits, and plain radiograph of the thoracolumbar spine revealed mild scoliosis and irregularity at L1 vertebra. Subsequent imaging studies revealed a comminuted, burst fracture of L1 with 90% spinal canal compromise. Her management consisted of early surgical treatment, and she had a quick recovery. Her postoperative course was unremarkable. We present this case to emphasize the importance of a comprehensive history taking in young patients with complaints of back pain and to highlight the role of imaging studies in the evaluation of back pain and in the assessment for surgical or nonoperative management.