Three-level bilateral pediculolysis following osteoporotic lumbar compression fracture.

BACKGROUND CONTEXT: Osteoporotic compression fractures frequently occur at the thoracolumbar junction as a result of anterior column failure. Fractures of the pedicles are much less common and are not known to be associated with a prior compression fracture. Bilateral pedicle fractures over several consecutive lumbar levels in an osteoporotic elderly patient have not been previously reported. PURPOSE: To draw attention to this unusual case and to review the relevant literature. STUDY DESIGN: A clinical case report of bilateral fractures of the pedicles from L3 through L5 in an 83-year-old male 2 years after an osteoporotic L3 compression fracture presenting with low back pain. METHODS: An 83-year-old male presented with low back pain two years after sustaining osteoporotic compression fracture at L3 due to a fall. He had another minor fall and his radiographic workup revealed bilateral fractures of the pedicles of the L3, L4, and L5 vertebrae. The patient was treated nonoperatively. RESULTS: The patient's symptoms improved without surgical intervention. Subsequent radiographic evaluation with plain films, computed tomography, and bone scan demonstrated union of the fractured pedicles. CONCLUSIONS: In this uncommon case of bilateral lumbar pedicle fractures over three consecutive levels, isolated failure of the posterior rather than the anterior column occurred. This unusual fracture pattern may have been precipitated by the previous vertebral compression fracture. Nonsurgical management may result in acceptable clinical outcome.