Fractures of the thoracic and lumbar vertebrae as a direct consequence of generalized epileptic convulsions are the most common non-traumatic type of fracture complicating epileptic seizures. The majority of these fractures are compression fractures that occur with minimal symptoms and virtually no permanent neurological sequela. Nevertheless, muscle contractions generated during generalized motor seizures can result in severe axial skeletal trauma and grave neurological complications. We describe the case of a 35-year-old man who suffered a burst fracture of the first lumbar vertebral body and acute conus medullaris-cauda equina syndrome as a direct consequence of a single grand mal seizure. The aim of this report is to draw attention to this serious complication of generalized convulsive seizures and alert readers to epilepsy-related vertebral fractures. Diagnosis and management of acute cauda equina-conus medullaris syndrome caused by lumbar fracture are reviewed.