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

Abstract

<jats:p>Spontaneous bilateral pedicle fractures of the lumbar spine are rare, and an optimal surgical treatment has not been suggested. The authors report the case of a 50-year-old woman who presented with low-back pain and right leg radiating pain of 1 year’s duration. Radiological studies revealed a spontaneous bilateral pedicle fracture of L-5. All efforts at conservative treatment failed, and the patient underwent surgery for osteosynthesis of the fractured pedicle using bilateral pedicle screws connected with a bent rod. Her low-back and right leg pain were relieved postoperatively. A CT scan performed 3 months postoperatively revealed the disappearance of the pedicle fracture gap and presence of newly formed bony trabeculation. In rare cases of spontaneous bilateral pedicle fracture of the lumbar spine, osteosynthesis of the fractured pedicle using bilateral pedicle screws and a bent rod is a motion-preserving technique that may be an effective option when conservative management has failed.</jats:p>

Percutaneous Instrumentation of a Complex Lumbar Spine Fracture with Bilateral Pedicle Dissociation: Case Report and Technical Note

“…They inserted bilateral pedicles screws at L5 to reduce the pedicle fractures and then resected the lower aspect of the L5 spinous process to place a rod across the lamina, thus connecting the screws while simultaneously avoiding the need for fusion at adjacent levels. 10 This approach could not be applied in our case because the traumatic mechanism of injury caused a significant amount of instability and kyphotic deformity at multiple levels.…”

A study on the puncture method of extrapedicular infiltration anesthesia applied during lumbar percutaneous vertebroplasty or percutaneous kyphoplasty

“…Additionally, bilateral puncture is not required, reducing the operative time and decreasing the radiation frequency. Furthermore, the integrity of the pedicle cortex is maintained, avoiding iatrogenic pedicle fracture and preventing the destruction of the axial or lateral biomechanical stability of the spine [19] …”

Adjacent Bi-level bilateral pedicle stress fractures after instrumented posterolateral lumbar fusion—a case report and review of the literature

“…However, stress fractures of the pedicle are much less common [9]. Vertebral pedicles are part of the posterior neural arch, and, like the pars interarticularis, are vulnerable to cyclic loads, although fractures of the former occur much more rarely than of the latter [10], mainly due to the fact that the pedicle has greater intrinsic strength and a shorter moment arm from the vertebral body and therefore can resist greater cyclic shear forces [11]. Cyron et al [12] reported 5 pedicle stress fractures compared to 53 pars interarticularis fractures in vertebras subjected to experimental cyclic shear loads.…”

“…Unilateral pedicle stress fracture has been clearly described in the literature and is commonly associated with contralateral spondylolysis [13][14][15][16]. On the other hand, bilateral pedicle stress fracture is an uncommon event and has been mostly associated with previous spine surgery [2,[17][18][19][20] and activity-related mechanical stress [11,21,22], although there are other case reports of bilateral pedicle stress fractures without the above-mentioned aetiologies-Kim et al [23] reported the case of a bilateral pedicle stress fracture on the second lumbar vertebra with spondylolisthesis in a 63-year-old female patient in the setting of an ankylosing spondylitis; Sadiq [9] reported the case of a bilateral pedicle stress fractures of the second lumbar vertebra in a 36-year-old patient with a sedentary lifestyle and with no risk factor or inciting event; Han et al [10] also reported a bilateral pedicle fracture of L5 on a 50-year-old female without an inciting event or cause; Doita et al [7] reported 2 cases of bilateral pedicle stress fractures. The first case was a 57-year-old male patient with a lumbar canal stenosis and bilateral pedicle stress fracture on L4.…”