Bilateral pedicle stress fracture in the lumbar spine of a sedentary office worker

Abstract

A case of bilateral pedicle fracture in the lumbar spine of a sedentary office worker is being presented. No such case has been reported in the literature previously. Bilateral pedicle fracture is a rare entity. Few cases have been reported in literature. All the reported cases had some underlying causative factors like degenerative spine disease, previous spinal surgery or stress-related activities, e.g. athletes. Our case is a 36-year-old sedentary office worker with none of the factors mentioned. We present a case of a 36-year-old sedentary worker with long-standing low backache. There were no root tension signs. Plain radiographs were inconclusive. The patient had a CT scan. The CT scan revealed long-standing defects in the pedicles of L2 vertebra with pseudoarthrosis. Infiltration with anaesthetic relieved the symptoms. Our patient was managed conservatively with spine rehabilitation physiotherapy program. Pedicle fracture can develop due to abnormal stresses in the pedicle either because of previous spinal surgery or spondylitic changes in the spine. Bilateral pedicle fracture in the absence of these conditions is extremely rare.

Posterior osteosynthesis of a spontaneous bilateral pedicle fracture of the lumbar spine

“…8,11,12,15,18,19,21 However, reports of bilateral pedicle fractures without significant trauma, surgery, or a bony abnormality are limited. 14,16,20 We report a case of spontaneous bilateral pedicle fracture of L-5 in a middle-aged woman and describe the successful treatment with a motion-preserving surgical reconstruction technique. …”

Bilateral pedicle stress fracture in a patient with osteoporotic compression fracture

“…The spine and the hip are the most common fracture sites secondary to osteoporosis. However, stress fractures of the pedicle are much less common [8,9,11,[13][14][15][16]18]. In the present case, postmenopausal osteoporosis is a predisposing factor for the bilateral pedicle fracture because an osteoporotic compression fracture had occurred before this fracture.…”

“…Most pedicle stress fractures have been reported in association with previous spine surgery [9,11,14] or stress-related activities [8,13,16,18] such as in highly active athletes. However, there have been few reports of bilateral stress fractures of the pedicle without other injuries or predisposing factors [15]. We report an uncommon case of bilateral pedicle stress fracture of L4 in a patient with L5 osteoporotic compression fracture without the history of trauma.…”

“…Almost all reported cases have had some underlying causative factors like previous spine surgery [9,11,14] or have occurred as a result of stress-related activities, such as in athletes [8,13,16,18]. To our knowledge, only one case has been previously reported of bilateral pedicle fracture in the absence of previous spinal surgery or stress-related activities [15]. The pedicle has greater intrinsic strength and a shorter moment arm from the vertebral body and therefore can resist greater cyclic shear forces [14].…”

Multi-level, bilateral pedicle fractures: case report

“…Bilateral pedicle stress fracture is a rare entity and we found that few cases have been reported in literature and underlying causative factors like previous spine surgery, spondylolysis or spondylolisthesis were described in these cases (2,(6)(7)(8)13). The pedicle may be exposed to increased forces after spine surgery, especially after spinal fusion, and the few pedicle stress fracture cases after surgery that occurred at the most proximal level of the fusion have been reported (3,9,12).…”