Early sacral stress fracture after reduction of spondylolisthesis and lumbosacral fixation: Case report

Daryl R. Fourney, Sujit S. Prabhu, Zvi R. Cohen, Ziya L. Gokaslan, Laurence D. Rhines, Regis W. Haid, Michael G. Kaiser, Paul C. McCormick, Vincent C. Traynelis, Stephen Papadopoulos

Research output: Contribution to journalArticle

Abstract

OBJECTIVE AND IMPORTANCE: Early sacral fracture is an extremely rare complication of instrumented lumbosacral fusion seen in older, osteopenic women. Previous reports have attributed the problem to the use of multisegmental (three or more levels) fixation, with the transfer of stress forces from rigid spinal implants to the sacrum. We report the only case, to the best of our knowledge, of early sacral fracture after a two-level lumbosacral fusion and the only case of early sacral fracture after reduction of spondylolisthesis. CLINICAL PRESENTATION: A patient presented with a sudden recurrence of low back and buttock pain a few days after lumbosacral decompression, reduction of L5-S1 Grade II spondylolisthesis, and instrumented L5-S1 fusion, including posterior lumbar interbody fusion. A transverse sacral fracture was found on plain x-rays 4 weeks later. INTERVENTION: Symptoms improved with brace therapy and medical treatment for osteoporosis. CONCLUSION: Early sacral fracture is a rare cause of pain after instrumented lumbosacral fusion. Although the transfer of loads from rigid spinal implants to adjacent segments is particularly problematic for multisegmental fusions, patients with short-segment constructs may also be affected. Active reduction of spondylolisthesis may provide additional adjacent segment stress contributing to this complication.

Original languageEnglish (US)
Pages (from-to)1507-1511
Number of pages5
JournalNeurosurgery
Volume51
Issue number6
DOIs
StatePublished - Dec 1 2002
Externally publishedYes

Fingerprint

Spondylolisthesis
Fracture Fixation
Stress Fractures
Sacrum
Braces
Buttocks
Low Back Pain
Decompression
Osteoporosis
X-Rays
Recurrence
Pain
Therapeutics

Keywords

  • Fracture
  • Lumbosacral spine
  • Pedicle screw
  • Sacrum
  • Spinal fusion
  • Spondylolisthesis

ASJC Scopus subject areas

  • Clinical Neurology
  • Surgery

Cite this

Fourney, D. R., Prabhu, S. S., Cohen, Z. R., Gokaslan, Z. L., Rhines, L. D., Haid, R. W., ... Papadopoulos, S. (2002). Early sacral stress fracture after reduction of spondylolisthesis and lumbosacral fixation: Case report. Neurosurgery, 51(6), 1507-1511. https://doi.org/10.1097/00006123-200212000-00024

Early sacral stress fracture after reduction of spondylolisthesis and lumbosacral fixation : Case report. / Fourney, Daryl R.; Prabhu, Sujit S.; Cohen, Zvi R.; Gokaslan, Ziya L.; Rhines, Laurence D.; Haid, Regis W.; Kaiser, Michael G.; McCormick, Paul C.; Traynelis, Vincent C.; Papadopoulos, Stephen.

In: Neurosurgery, Vol. 51, No. 6, 01.12.2002, p. 1507-1511.

Research output: Contribution to journalArticle

Fourney, DR, Prabhu, SS, Cohen, ZR, Gokaslan, ZL, Rhines, LD, Haid, RW, Kaiser, MG, McCormick, PC, Traynelis, VC & Papadopoulos, S 2002, 'Early sacral stress fracture after reduction of spondylolisthesis and lumbosacral fixation: Case report', Neurosurgery, vol. 51, no. 6, pp. 1507-1511. https://doi.org/10.1097/00006123-200212000-00024
Fourney, Daryl R. ; Prabhu, Sujit S. ; Cohen, Zvi R. ; Gokaslan, Ziya L. ; Rhines, Laurence D. ; Haid, Regis W. ; Kaiser, Michael G. ; McCormick, Paul C. ; Traynelis, Vincent C. ; Papadopoulos, Stephen. / Early sacral stress fracture after reduction of spondylolisthesis and lumbosacral fixation : Case report. In: Neurosurgery. 2002 ; Vol. 51, No. 6. pp. 1507-1511.
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AU - Fourney, Daryl R.

AU - Prabhu, Sujit S.

AU - Cohen, Zvi R.

AU - Gokaslan, Ziya L.

AU - Rhines, Laurence D.

AU - Haid, Regis W.

AU - Kaiser, Michael G.

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AU - Papadopoulos, Stephen

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AB - OBJECTIVE AND IMPORTANCE: Early sacral fracture is an extremely rare complication of instrumented lumbosacral fusion seen in older, osteopenic women. Previous reports have attributed the problem to the use of multisegmental (three or more levels) fixation, with the transfer of stress forces from rigid spinal implants to the sacrum. We report the only case, to the best of our knowledge, of early sacral fracture after a two-level lumbosacral fusion and the only case of early sacral fracture after reduction of spondylolisthesis. CLINICAL PRESENTATION: A patient presented with a sudden recurrence of low back and buttock pain a few days after lumbosacral decompression, reduction of L5-S1 Grade II spondylolisthesis, and instrumented L5-S1 fusion, including posterior lumbar interbody fusion. A transverse sacral fracture was found on plain x-rays 4 weeks later. INTERVENTION: Symptoms improved with brace therapy and medical treatment for osteoporosis. CONCLUSION: Early sacral fracture is a rare cause of pain after instrumented lumbosacral fusion. Although the transfer of loads from rigid spinal implants to adjacent segments is particularly problematic for multisegmental fusions, patients with short-segment constructs may also be affected. Active reduction of spondylolisthesis may provide additional adjacent segment stress contributing to this complication.

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