Korean J Neurotrauma.  2017 Apr;13(1):54-56. 10.13004/kjnt.2017.13.1.54.

Adjacent Bilateral Stress Pedicle Fractures after Instrumented Lumbar Fusion: A Case Report

• Kim HS
• Ha SW
• Ju CI
• Kim SW

• KMID: 2378252
• DOI: http://doi.org/10.13004/kjnt.2017.13.1.54

Abstract

Bilateral pedicle stress fractures are rare even in the elderly. Bilateral pedicle fractures are due to post-surgical complications at the level of fusion or stress related activities in most cases. The authors describe a unique case of adjacent L4 bilateral pedicle fractures, which developed 4 years after anterior lumbar interbody fusion with bone cement augmented screw fixation at the L5-S1 level. As far as the authors' knowledge, no similar case has been previously reported in the literature. The pathophysiological mechanism of this rare entity is discussed with review of relevant literature.

Keyword

Fractures bone; Lumbar vertebrae; Spinal fusion

MeSH Terms

Aged
Fractures, Stress
Humans
Lumbar Vertebrae
Spinal Fusion

Figure

• 

  FIGURE 1 Radiological studies performed 4 years before fracture presentation. (A,B) Simple lateral radiograph and magnetic resonance image after anterior lumbar interbody fusion with screw fixation showing no pedicle fracture at the L4 level.

• 

  FIGURE 2 Radiological studies performed at 4 years after anterior lumbar interbody fusion with screw fixation. (A-C) Simple lateral radiograph and magnetic resonance images suggestive of pedicle fracture at the L4 level (arrows). (D,E) Computed tomography scans showing bilateral pedicle fractures without surrounding sclerosis (arrows).

• 

  FIGURE 3 Post-operative simple lateral radiograph shows extension of interbody fusion at L4-S1.

Reference

1. Gunzburg R, Fraser RD. Stress fracture of the lumbar pedicle. Case reports of “pediculolysis” and review of the literature. Spine (Phila Pa 1976). 1991; 16:185–189. PMID: 2011774.

2. Ha KY, Kim YH. Bilateral pedicle stress fracture after instrumented posterolateral lumbar fusion: a case report. Spine (Phila Pa 1976). 2003; 28:E158–E160. PMID: 12698135.

3. Hajjioui A, Khazzani H, Sbihi S, Bahiri R, Benchekroune B, Hajjaj-Hassouni N. Spondylolisthesis on bilateral pedicle stress fracture in the lumbar spine: a case study. Ann Phys Rehabil Med. 2011; 54:53–58. PMID: 21292582.

4. Kim HS, Ju CI, Kim SW. Bilateral pedicle stress fracture accompanying spondylolysis in a patient with ankylosing spondylitis. J Korean Neurosurg Soc. 2010; 48:70–72. PMID: 20717516.

5. Kim HS, Kim SW, Lee WT. Spondylolisthesis accompanying bilateral pedicle stress fracture at two vertebrae. J Korean Neurosurg Soc. 2012; 51:388–390. PMID: 22949973.

6. Kim SW, Kim HS, Kim HS. Unusual osteoporotic stress fracture: adjacent bilateral pedicle fractures. Int J Rheum Dis. 2014; 8. 19.

7. Knight RQ, Chan DP. Idiopathic scoliosis with unusual stress fracture of the pedicle within solid fusion mass. A case report. Spine (Phila Pa 1976). 1992; 17:849–851. PMID: 1502653.

8. Macdessi SJ, Leong AK, Bentivoglio JE. Pedicle fracture after instrumented posterolateral lumbar fusion: a case report. Spine (Phila Pa 1976). 2001; 26:580–582. PMID: 11242389.

9. Robertson PA, Grobler LJ. Stress fracture of the pedicle. A late complication of posterolateral lumbar fusion. Spine (Phila Pa 1976). 1993; 18:930–932. PMID: 8316897.

10. Tribus CB, Bradford DS. Bilateral pedicular stress fractures after successful posterior spinal fusion for adult idiopathic scoliosis. Spine (Phila Pa 1976). 1993; 18:1222–1225. PMID: 8362330.