Postpartum Sacral Stress Fracture Mimicking Lumbar Radiculopathy in a Patient With Pregnancy-Associated Osteoporosis

Abstract

Postpartum sacral fracture is relatively rare, and its diagnosis is often delayed. We herein report such a case of a 28-year-old patient who presented with an insidious-onset lower back pain, left buttock pain, and radicular symptoms mimicking lumbar radiculopathy. Laboratory tests showed a decreased 25-hydroxy vitamin D level, and the bone mineral densitometry of both femurs was below the expected range. Plain radiographs of the lumbar spine and pelvis showed no definite abnormality, but lumbosacral spinal magnetic resonance imaging identified a left sacral fracture. Symptoms were alleviated with rest and oral analgesic treatment.

Sacral Stress Fracture Mimicking Lumbar Radiculopathy in a Mounted Police Officer: Case Report and Literature Review

“…A review by Kahanov et al found that ∼95% of patients with sacral stress fractures initially presented with lower back pain or buttock pain and that neurologic symptoms were an uncommon presenting complaint with radicular symptoms occurring in only 2% of cases. 17 18 Back pain symptoms are typically localized to one sacral area, worse with standing or activity, and relieved by rest or lying flat, and they may be associated with strenuous impact activities in cases of SFF. Although no physical examination features are specific to sacral stress fractures, findings include an antalgic gait, localized tenderness over the sacral paraspinal area, and positive clinical tests that include the Gaenslen test, squish test, or Patrick test.…”

“…Although no physical examination features are specific to sacral stress fractures, findings include an antalgic gait, localized tenderness over the sacral paraspinal area, and positive clinical tests that include the Gaenslen test, squish test, or Patrick test. 17 If present, the commonest radiculopathies involve the S1 or S2 distribution. 19 Unfortunately, the differential diagnosis for lower back pain is extensive and includes musculoskeletal sprains, lumbar disk disease, facet arthropathy, sacroiliac joint pathologies, spondyloarthropathies, spondylolysis, spinal stenosis, and neoplasms.…”

“… 19 Unfortunately, the differential diagnosis for lower back pain is extensive and includes musculoskeletal sprains, lumbar disk disease, facet arthropathy, sacroiliac joint pathologies, spondyloarthropathies, spondylolysis, spinal stenosis, and neoplasms. 17 20 Furthermore, complaints of back pain in association with radicular symptoms can easily distract the physician from the correct diagnosis and may explain why the majority of sacral stress fractures are typically not diagnosed until 4 weeks after the patient's initial presentation. 17 …”

“… 17 20 Furthermore, complaints of back pain in association with radicular symptoms can easily distract the physician from the correct diagnosis and may explain why the majority of sacral stress fractures are typically not diagnosed until 4 weeks after the patient's initial presentation. 17 …”

Low Back Pain in Pregnancy: Investigations, Management, and Role of Neuraxial Analgesia and Anaesthesia: A Systematic Review

“…Axial loading of the spine may compress intervertebral discs, reduce disc height and cause disc protrusion culminating in radicular symptoms. Osteoporosis in pregnancy has been associated with vertebral [48] and sacral stress fractures [60] . Other rare pathologies may include osteomyelitis [99] and spinal tumours [91,100] .…”