Pedicular stress fracture in the lumbar spine

Contralateral Spondylolysis and Fracture of the Lumbar Pedicle in a Young Athlete

STUDY DESIGN

Clinical case report of unilateral pedicular stress fracture with a contralateral spondylolysis in a male high-school athlete presenting with low back pain.

OBJECTIVE

To report this uncommon cause of low back pain in an adolescent athlete, and review the relevant literature.

SUMMARY OF BACKGROUND DATA

The incidence of spondylolysis in the Caucasian population was found to be about 3% to 6%. This number is probably higher in the athletic adolescent age group, with reports ranging from 8% to 15%. Spondylolysis may be associated with pedicle fracture, usually on the contralateral side. This is an uncommon phenomenon that is not well described in the adolescent age group.

METHODS

A 16-year-old male athlete presents with low back pain and limitation in sports as well as in daily activities. Clinical evaluation was suspicious for, and radiographic evaluation revealed left-sided L5 spondylolysis as well as contralateral L5 pedicle fracture. Conservative management included Boston Overlapping brace, external electrical stimulation, modification of activities, and a comprehensive physical therapy program.

RESULTS

Radiological evaluation revealed persistent left L5 pars defect and advanced healing of the contralateral pedicle fracture. The patient achieved complete pain relief and returned to varsity level sporting activity.

CONCLUSION

Complete radiographic and clinical healing of the pedicle defect was observed, with return competitive varsity-level football without symptoms.

LEVEL OF EVIDENCE

5.

Unilateral Pedicle Fracture Accompanying Spondylolytic Spondylolisthesis

Unilateral pedicle stress fracture accompanying spondylolytic spondylolisthesis is rare even in the elderly. Most are associated with major trauma, previous spine surgery, or stress-related activity. Here, the authors describe an unique case of unilateral pedicle fracture associated with spondylolytic spondylolisthesis at the L5 level, which was successfully treated by posterior lumbar interbody fusion with screw fixation at the L5-S1 level. As far as the authors' knowledge, no such case has been previously reported in the literature. The pathophysiological mechanism of this uncommon entity is discussed and a review of relevant literature is included.

Multiple lumbar pedicle fractures in osteopetrosis: a case report

STUDY DESIGN

Single case report.

OBJECTIVE

To report the observation of multiple lumbar pedicle fractures in a patient with osteopetrosis.

SUMMARY OF BACKGROUND DATA

Osteopetrosis is characterized by osteoclast dysfunction, impaired bone resorption, and poor bone remodeling. As a result, the bone is brittle but hard and is referred to as "marble bone disease." Although long bone fractures are relatively common, fractures of the spine are rare. Spondylolysis has been reported in the cervical and lumbar spine, and pedicle fractures have been reported in the cervical spine. We report the case of a patient with autosomal dominant osteopetrosis with multiple lumbar pedicle fractures. To the best of our knowledge, there have been no previous reports of multiple lumbar pedicle fractures in osteopetrosis.

METHODS

A 73-year-old woman, with a known history of osteopetrosis, presented with acute nonradiating low back pain following a bout of coughing. The lower limb neurology and bladder and bowel function were normal. The imaging findings, clinical course, and treatment are discussed.

RESULTS

Initial computed tomography scans of the patient revealed the presence of multiple pedicle fractures with spondylolysis. The patient was advised bed rest for the first 3 days, and when the acute pain subsided, she was permitted to ambulate with a lumbosacral corset. The patient was asymptomatic for 8 months, when she was readmitted with another episode of acute low back pain. The CT scan revealed fresh fracture of the L4 pedicle, which was not seen on the previous scan. The pain settled down again with conservative measures.

CONCLUSION

This case report discusses the rare occurrence of multiple lumbar pedicle fractures and pars interarticularis (spondylolysis) fractures in a patient with osteopetrosis.

Contralateral pedicular fracture with unilateral spondylolysis

Although most authors regard contralateral pedicular fracture with unilateral spondylolysis as an unstable condition and recommend surgical management when immobilization fails in promoting bony healing of the fracture, few researchers have investigated the natural history of pedicle fracture or the causal relationship between symptoms and the fracture. In addition, there are no detailed guidelines that address the management of this disease. We report a rare case of contralateral pedicular fracture associated with unilateral spondylolysis at the L5 level which was successfully treated by rehabilitation with activity modification.

Fresh stress fractures of lumbar pedicles in an adolescent male ballet dancer: case report and literature review

Stress fracture in the pars interarticularis is a common cause of low back pain in young athletes. Pedicle stress fractures have also been reported in adolescent sport players, and most of them were associated with contralateral spondylolysis. Only a few cases with bilateral pedicle stress fractures have been reported. We report a 14-year-old ballet dancer with fresh bilateral pedicle fractures treated conservatively, together with a review of the literature.

Bilateral pedicle stress fracture in a patient with lumbar spinal stenosis: a case report

STUDY DESIGN

A case of bilateral pedicle stress fracture in a patient with lumbar spinal stenosis is reported, and the literature is reviewed.

OBJECTIVES

To report a rare case of bilateral pedicle stress fracture without a history of major trauma or surgery.

SUMMARY OF BACKGROUND DATA

Bilateral pedicle fracture is a rare entity and few cases have been reported in the literature. All the reported cases had some underlying causative factors like previous spine surgery or stress-related activities. To the best of the authors' knowledge, only 1 case of bilateral pedicle stress fracture without a history of trauma, previous spine surgery, or stress-related activities has been reported.

METHOD

A 57-year-old man presented with low back pain and radiating pain in left leg that was exacerbated after walking. Plain radiograph showed severe degenerative changes at L4-5 level. Magnetic resonance imaging revealed lumbar spinal stenosis at L2-3, 3-4, and 4-5 levels. A computed tomography demonstrated bilateral L4 pedicle stress fracture. The patient was treated with decompressive laminectomies of L3-5, followed by posterior spinal fusion with rigid pedicle screw fixation and autogenous bone graft mixed with hydroxyapatite.

RESULTS

The patient achieved pain relief and returned to normal activity.

CONCLUSIONS

Stress fracture of the pedicle within the proximal vertebra of a severely degenerated lumbar spine is an uncommon entity. It may, however, be an additional source of symptoms in patients with lumbar spinal stenosis who present with further back pain. Surgeons caring for this group of patients should be aware of this condition.

Bilateral pedicle stress fracture in a patient with osteoporotic compression fracture

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.

Acute L5 pedicle fracture and contralateral spondylolysis in a 12-year-old boy: a case report

Acute unilateral L5 pedicle fracture associated with a pre-existing contralateral spondylolysis is a rare lesion. We report a case in a non-competitive 12-year-old boy. We present the clinical, radiological and specific management of this rare condition. The clinical and radiological draft of this patient was reviewed. The follow-up was 30 months after fracture healing. Some cases reported in the literature were analyzed and our clinical findings and therapeutic strategy was compared and discussed. Non-operative treatment was done including full-time bracing in a modified Boston brace incorporating one thigh for 3 months. Plain radiographs and computed tomographic (CT)-scan performed at 3 and 6 months showed progressive healing of the pedicle fracture and no modification of the contralateral isthmic spondylolytic lesion. At final follow-up, the patient was asymptomatic and resumed all his activities. In skeletally immature patients, we think that conservative treatment should be considered as a treatment option for this unusual injury.

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.

Stress fractures in the spine and sacrum

Stress fractures of the pars, pedicle, and sacrum are important considerations in the differential diagnosis of lower back pain in the child or adolescent athlete. A thorough history and physical examination as well as a high index of suspicion are essential when assessing a patient with lower back pain. Diagnostic imaging, including radiographs, bone scans, CT scans, and other imaging modalities are important for further narrowing the diagnosis. The early identification and proper management of stress fractures of the pars, pedicle, and sacrum are integral in the prevention of stress fractures in the adolescent athlete population. This article reviews current concepts in the assessment and management of stress fractures of the lumbosacral spine, particularly of the pars (spondylolysis), pedicles, and sacrum.

Bilateral pedicle stress fractures in a female athlete: case report and review of the literature

STUDY DESIGN

Clinical case report of bilateral stress fractures of the pedicle in a female athlete presenting with back pain.

OBJECTIVES

To report this unusual case and surgical treatment and to review the relevant literature.

SUMMARY OF BACKGROUND DATA

Low back pain is a frequent complaint in athletes, with the majority of cases being related to muscular or soft tissue etiology. Spondylolysis, or pars fracture, is the most common injury of the neural arch. Stress fracture of the pedicle is a much less common occurrence. Bilateral pedicle fractures in an otherwise healthy athlete has not been previously reported in the orthopedic literature.

METHODS

A 19-year-old female athlete presented with low back pain limiting sports and daily activities. Radiographic workup revealed bilateral stress fractures of the pedicles of the L5 vertebra. Circumferential fusion of the L5-S1 segment was performed after failure of conservative treatment. Anterior interbody structural allograft and a vertical mesh cage were combined with instrumented posterolateral fusion using segmental pedicle screws and autogenous iliac crest bone graft.

RESULTS

The patient achieved complete pain relief, solid fusion, and return to normal function.

CONCLUSIONS

In this uncommon case of bilateral stress fractures of the pedicle, circumferential fusion assures full immobilization of the injured motion segment and assures a high probability of successful healing.

Pedicular stress fracture in lumbar spine

The purpose of this article is to report two cases of pedicular stress fracture of the lumbar spine, which is an uncommon cause of low back and leg pain. The relevant literature is reviewed and features of the cases that differ from those already reported are highlighted. One of our cases of pediculolysis is the first in the literature for that is caused by rotational instability induced by laminectomy. The remodeling of the fractured pedicle was striking when compared with its normal counterpart. To the authors' knowledge, this is the first report of a pediculolysis with T2-weighted imaging findings. In addition, we report the computed tomographic (CT) and magnetic resonance (MR) imaging findings of a healed pediculolysis that has not been reported previously.