Bilateral pedicle stress fracture in a patient with osteoporotic compression fracture |
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Authors: | Minoru Doita Yoshihiro Ando Soichiro Hirata Hitoshi Ishikawa and Masahiro Kurosaka |
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Institution: | (1) Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, Kobe, Japan;(2) Department of Orthopedic Surgery, Ishikawa Hospital, Himeji, Japan;(3) 7-5-1 Kusunoki-cho, Chuo-ku, Kobe 650-0017, Japan |
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Abstract: | A case of bilateral pedicle stress fracture of L4 in a patient with osteoporotic compression fracture of L5 and without a
history of major trauma or surgery is reported, and the literature is reviewed. Bilateral pedicle fracture is a rare entity
and few cases have been reported in the literature. All reported cases had some underlying causative factors like previous
spine surgery or stress related activities. To the best of the authors’ knowledge, only one case of bilateral pedicle stress
fracture without a history of trauma, previous spine surgery, or stress-related activities has been reported. A 77-year-old
woman presented with severe low back pain and radiating pain in the right leg that was exacerbated after standing and walking.
Plain radiograph showed pathological fracture at L5 level. Magnetic resonance imaging (MRI) revealed the compression of dural
sac at L5 level. CT scan taken 3 months after admission revealed bilateral pedicle fractures through L4. The patient was treated
with decompressive laminectomies of L4, followed by posterior spinal fusion with rigid pedicle screw fixation and autogenous
bone graft mixed with hydroxyapatite. The patient achieved pain relief and returned to normal activity. Stress fracture of
the pedicle within the proximal vertebra of an osteoporotic compression fracture of lumbar spine is an uncommon entity. It
may, however, be an additional source of symptoms in patients with osteoporosis who present with further back pain. Surgeons
caring for this group of patients should be aware of this condition. |
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