Risk factors for L5 pedicle fractures after single-level posterior spinal fusion

Abstract

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Bilateral L5 pedicle fracture with L5–S1 spondylolisthesis after single-level L4–5 posterior lumbar interbody fusion: illustrative case

“…A previous study has demonstrated that patients with high PI, high LL, and high SS may be at risk of developing pedicle fractures. 15 Interestingly, however, the study demonstrated no significant difference in PI-LL mismatch between fracture and nonfracture groups, suggesting that spinopelvic imbalance may not successfully predict this fracture. We believe that the anterior shift of the loading axis in the lumbosacral region is associated with excessive shear force on the pedicle.…”

“…Recently, Wanivenhaus et al 15 reported a case-control study of L5 pedicle fracture after L4–5 PLIF/TLIF and stated that the frequency of this complication is 3.2%. However, their study is currently the only report from a single institute, and no similar cases have been reported in other articles investigating L5–S1 adjacent segment disease (ASD) after L4–5 fusion surgery.…”

Superior metal artifact reduction of tin-filtered low-dose CT in imaging of lumbar spinal instrumentation compared to conventional computed tomography

“…Lumbar instrumentation is a very common surgical procedure in degenerative diseases of the lumbar spine and postoperative evaluation is routinely performed by standard radiographs as first-line imaging, usually with anteroposterior and lateral views [ 1 , 2 ]. In a subset of patients, especially with persistent pain, an additional CT scan is performed to exclude fractures, misplacement or loosening of metal implants [ 3 ]. However, this results in a much higher total radiation dose for the patient compared to the evaluation with radiographs, despite the benefit of detailed cross-sectional anatomic information provided by the CT [ 4 , 5 ].…”