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Bilateral pedicle stress fracture in a patient with osteoporotic compression fracture

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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References

  1. Abel MS (1985) Jogger’s fracture and other stress fractures of the lumbo-sacral spine. Skeletal Radiol 13:221–227. doi:10.1007/BF00350578

    PubMed  Article  CAS  Google Scholar 

  2. Aland C, Rineberg BA, Malberg M et al (1986) Fracture of the pedicle of the fourth lumbar vertebra associated with contralateral spondylolysis. Report of a case. J Bone Joint Surg Am 68:1454–1455

    PubMed  CAS  Google Scholar 

  3. Chong VF, Htoo MM (1997) Pedicular stress fracture in the lumbar spine. Australas Radiol 41:306–307. doi:10.1111/j.1440-1673.1997.tb00680.x

    PubMed  Article  CAS  Google Scholar 

  4. Cyron BM, Hutton WC, Troup JD (1976) Spondylolytic fractures. J Bone Joint Surg Br 58:462–466

    PubMed  Google Scholar 

  5. Cyron BM, Hutton WC (1978) The fatigue strength of the lumbar neural arch in spondylolysis. J Bone Joint Surg Br 60:234–238

    PubMed  Google Scholar 

  6. Garber JE, Wright AM (1986) Unilateral spondylolysis and contralateral pedicle fracture. Spine 11:63–66. doi:10.1097/00007632-198601000-00018

    PubMed  Article  CAS  Google Scholar 

  7. Guillodo Y, Botton E, Saraux A et al (2000) Contralateral spondylolysis and fracture of the lumbar pedicle in an elite female gymnast: a case report. Spine 25:2541–2543. doi:10.1097/00007632-200010010-00019

    PubMed  Article  CAS  Google Scholar 

  8. Gunzburg R, Fraser RD (1991) Stress fracture of the lumbar pedicle. Case reports of “Pediculolysis” and review of the literature. Spine 16:185–189

    PubMed  CAS  Article  Google Scholar 

  9. Ha KY, Kim YH (2003) Bilateral pedicle stress fracture after instrumented posterolateral lumbar fusion: a case report. Spine 28:E158–E160. doi:10.1097/00007632-200304150-00024

    PubMed  Article  Google Scholar 

  10. Knight RQ, Chan DP (1992) Idiopathic scoliosis with unusual stress fracture of the pedicle within solid fusion mass. A case report. Spine 17:849–851. doi:10.1097/00007632-199207000-00023

    PubMed  Article  CAS  Google Scholar 

  11. Macdessi SJ, Leong AK, Bentivoglio JE (2001) Pedicle fracture after instrumented posterolateral lumbar fusion: a case report. Spine 26:580–582. doi:10.1097/00007632-200103010-00026

    PubMed  Article  CAS  Google Scholar 

  12. Maurer SG, Wright KE, Bendo JA (2000) Iatrogenic spondylolysis leading to contralateral pedicular stress fracture and unstable spondylolisthesis: a case report. Spine 25:895–898. doi:10.1097/00007632-200004010-00022

    PubMed  Article  CAS  Google Scholar 

  13. Parvataneni HK, Nicholas SJ, McCance SE (2004) Bilateral pedicle stress fractures in a female athlete: case report and review of the literature. Spine 29:E19–E21. doi:10.1097/01.BRS.0000105988.43472.2B

    PubMed  Article  Google Scholar 

  14. Robertson PA, Grobler LJ (1993) Stress fracture of the pedicle. A late complication of posterolateral lumbar fusion. Spine 18:930–932. doi:10.1097/00007632-199306000-00021

    PubMed  CAS  Article  Google Scholar 

  15. Sadiq MZ (2006) Bilateral pedicle stress fracture in the lumbar spine of a sedentary office worker. Eur Spine J 15(Suppl 17):653–655. doi:10.1007/s00586-006-0184-y

    PubMed  Article  Google Scholar 

  16. Sirvanci M, Ulusoy L, Duran C (2002) Pedicular stress fracture in lumbar spine. Clin Imaging 26:187–193. doi:10.1016/S0899-7071(01)00389-8

    PubMed  Article  Google Scholar 

  17. Stanley D, Smith TW (1990) Contralateral pedicle stress fracture. An unusual complication of laminectomy. Spine 15:598–599

    PubMed  CAS  Google Scholar 

  18. Traughber PD, Havlina JM Jr (1991) Bilateral pedicle stress fractures: SPECT and CT features. J Comput Assist Tomogr 15:338–340. doi:10.1097/00004728-199103000-00033

    PubMed  Article  CAS  Google Scholar 

  19. Tribus CB, Bradford DS (1993) Bilateral pedicular stress fractures after successful posterior spinal fusion for adult idiopathic scoliosis. Spine 18:1222–1225. doi:10.1097/00007632-199307000-00016

    PubMed  Article  CAS  Google Scholar 

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Acknowledgments

The authors thank Ms. Janina Tubby for her help in preparing the manuscript.

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None of the author has any potential conflict of interest.

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Correspondence to Minoru Doita.

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Doita, M., Ando, Y., Hirata, S. et al. Bilateral pedicle stress fracture in a patient with osteoporotic compression fracture. Eur Spine J 18 (Suppl 2), 206–209 (2009). https://doi.org/10.1007/s00586-008-0816-5

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  • DOI: https://doi.org/10.1007/s00586-008-0816-5

Keywords

  • Pedicle fracture
  • Stress fracture
  • Osteoporosis
  • Low back pain
  • Lumbar spine