J Korean Soc Spine Surg.  2018 Mar;25(1):24-29. 10.4184/jkss.2018.25.1.24.

Sacral Stress Fracture Developing after Lumbosacral Fusion in a Patient with Spondylolisthesis: A Case Report

• Shin YE
• Jung JU
• Yoon SH

• KMID: 2408304
• DOI: http://doi.org/10.4184/jkss.2018.25.1.24

Abstract

STUDY DESIGN: Case report
OBJECTIVES
To report a case of sacral stress fracture that developed after lumbosacral fusion. SUMMARY OF LITERATURE REVIEW: Sacral stress fractures rarely develop after lumbosacral fusion, and osteoporosis, female sex, being over 60 years old, and long segment fusion are known risk factors.
MATERIALS AND METHODS
A 66-year-old woman with spondylolisthesis at L5 on S1 underwent posterior lumbar interbody fusion and posterior instrumentation. A sacral stress fracture was found 4 weeks after the first operation, and we performed posterior reduction and posterior instrumentation with S2 alar screws.
RESULTS
The patient was free from symptoms and no further displacement was found at 3 months after the last operation.
CONCLUSIONS
Sacral stress fracture after lumbosacral fusion can be treated with posterior reduction and posterior instrumentation with S2 alar screws.

Keyword

Sacrum; Stress fracture; Lumbosacral fusion

MeSH Terms

Aged
Female
Fractures, Stress*
Humans
Osteoporosis
Risk Factors
Sacrum
Spondylolisthesis*

Figure

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  Fig. 1. Preoperative plain radiographs: (A) standing (lateral view), (B) flexion, and (C) extension (lateral view). The radiographs show spondylolisthesis at L5 on S1 with instability and a neglected L1 spine compression fracture.

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  Fig. 2. Postoperative plain lateral radiograph shows the post-reduction state of spondylolisthesis at L5-S1.

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  Fig. 3. Plain lateral radiograph taken 4 weeks after the first operation shows a displaced sacral stress fracture just beneath the S1 pedicle screws.

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  Fig. 4. (A) Sagittal and (B) axial computed tomography images taken 4 weeks after the first operation show a displaced sacral stress fracture just beneath the S1 pedicle screws.

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  Fig. 5. Plain lateral radiograph taken after the second operation shows the well-reduced state of the sacral stress fracture.

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  Fig. 6. (A) Sagittal and (B) axial computed tomography images taken after the second operation show the well-reduced state of the sacral stress fracture.

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  Fig. 7. (A) Anteroposterior and (B) lateral plain radiographs taken 3 months after the third operation radiograph show the well-reduced state of the fracture and well-maintained instruments.

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