Sacral Insufficiency Fracture Following Short-Segment Lumbosacral Fusion: Case Series and Review of the Literature

Kolz, Joshua M.; Mitchell, Scott A.; Elder, Benjamin D.; Sebastian, Arjun S.; Huddleston, P.M.; Freedman, Brett A.

doi:10.1177/2192568220950332

Cited by 6 publications

(5 citation statements)

References 54 publications

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“…Hence, in such cases, MRI turns out to be superior as a diagnostic tool, even in occult SIF. MRI is helpful not only in the diagnosis of SIF, but also to rule out other associated pathologies such as a missed vertebral fracture or a lumbar canal stenosis [ 17 , 18 ]. Bone scanning is one of the most sensitive techniques for detecting SIF.…”

Section: Discussionmentioning

confidence: 99%

Superiority of MRI for Evaluation of Sacral Insufficiency Fracture

Yamauchi

Sharma

Chandra

et al. 2022

JCM

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Study Design: Retrospective observational study. Background: Sacral insufficiency fractures (SIF) are relatively rare fractures and difficult to diagnose on plain radiographs. The primary objective of the present study was to evaluate the role of lumbar magnetic resonance imaging (MRI) for the diagnosis of SIF. The secondary objective was to identify the classification of SIF by computed tomography (CT). Methods: A total of 77 (Male 11, female 66, mean 80.3 years) people were included in this study. Inclusion criteria for this study were: age ≥60 years and no history of high energy trauma. Exclusion criteria were high energy trauma and a current history of malignancy. Differences in the fracture detection and description in the various radiologic procedures were evaluated. Fracture patterns were evaluated with CT. The detection rates of additional pathologies in the MRI of the pelvis and lumbar spine were also recorded. Results: The sensitivities for SIF were 28.5% in radiographs and 94.2% in CT, and all fractures were detected in MRI. MRI showed a more complex fracture pattern compared with CT in 65% of the cases. We observed 71.4% of single SIFs, 9.1% with other spinal fractures, 13.0% with other pelvic fractures, and 7.8% with other fractures. According to the SIF fracture pattern, the H/U type was 40.2%, transverse type was 33.7%, λ/T type was 24.7%, unilateral vertical type was 1.3%, and bilateral vertical type was 0%. Conclusions: an MRI of the lumbar spine including the sacrum with a coronal fat-suppressed T2-weighted image is useful for elderly patients with suddenly increasing low back pain at an early stage. This procedure improves an early SIF detection, recognition of concomitant pathologies, and adequate treatment for the patients.

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Section: Discussionmentioning

confidence: 99%

Superiority of MRI for Evaluation of Sacral Insufficiency Fracture

Yamauchi

Sharma

Chandra

et al. 2022

JCM

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“…Complications can be associated with either the ALIF or the posterior instrumentation portions of the procedure. Reported complications are diverse and range from vascular injuries, bowel and ureter injuries, postoperative bleeding requiring reoperation, postoperative paralytic ileus, sacral insufficiency fracture, pseudoarthrosis, and neurological injury [9][10][11][12][13]. A review article on iatrogenic neurologic deficits after lumbar spine surgery reported a 4.1% rate of newonset neurologic injury after anterior or lateral lumbar fusion surgery [10].…”

Section: Discussionmentioning

confidence: 99%

“…The ALIF procedure has been associated with diverse complications such as vascular injuries, injuries to other structures in the peritoneal compartment, fractures, pseudoarthrosis, and neural injury [9][10][11][12][13]. At the L5-S1 level, the ALIF has been associated with L5 radiculopathies [14,15].…”

Section: Introductionmentioning

confidence: 99%

A Technical Nuance to Avoid Lumbar Five Radiculopathy with Anterior Lumbar Fusion and Posterior Instrumentation

Neal

Kalani

Lyons

2021

Case Reports in Orthopedics

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The anterior lumbar interbody fusion (ALIF) is a well-established procedure used to treat a multitude of spinal pathologies. When performed at the L5-S1 level, the ALIF is often supplemented with posterior pedicle screw and rod fixation. Because the interbody device can restore disk and foraminal height, one benefit of the ALIF procedure is indirect neural decompression in the spinal canal and neural foramina. If the contour of the posterior rod is not matched to the exact position of the tulip heads on the pedicle screws, spondylolisthesis can be introduced, leading to foraminal stenosis and nerve compression. This concern is particularly germane when the posterior instrumentation is placed percutaneously without any direct foraminal decompression. In this report, we describe a patient who had an L4-S1 ALIF, resulting in new L5-S1 retrolisthesis and worsening L5 radiculopathy. Technical nuances and avoidance strategies are discussed.

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“…This is especially important as lumbosacral pseudarthrosis may cause sacral insufficiency fractures. 55 Regarding interbody devices, the primarily used materials have been titanium and polyetheretherketone (PEEK). While PEEK theoretically lowers the risk of subsidence because its elastic modulus is closer to that of corticocancellous bone, the literature does not clearly favor one material over the other.…”

Section: Smentioning

confidence: 99%

“…This is especially important as lumbosacral pseudarthrosis may cause sacral insufficiency fractures. 55…”

Section: Multidisciplinary Strategies In Osteoporotic Patientsmentioning

confidence: 99%

Avoiding Spinal Implant Failures in Osteoporotic Patients: A Narrative Review

Schömig

Becker

Schönnagel

et al. 2023

Global Spine Journal

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Study design Narrative review. Objectives With an aging population, the prevalence of osteoporosis is continuously rising. As osseous integrity is crucial for bony fusion and implant stability, previous studies have shown osteoporosis to be associated with an increased risk for implant failure and higher reoperation rates after spine surgery. Thus, our review’s purpose was to provide an update of evidence-based solutions in the surgical treatment of osteoporosis patients. Methods We summarize the existing literature regarding changes associated with decreased bone mineral density (BMD) and resulting biomechanical implications for the spine as well as multidisciplinary treatment strategies to avoid implant failures in osteoporotic patients. Results Osteoporosis is caused by an uncoupling of the bone remodeling cycle based on an unbalancing of bone resorption and formation and resulting reduced BMD. The reduction in trabecular structure, increased porosity of cancellous bone and decreased cross-linking between trabeculae cause a higher risk of complications after spinal implant-based surgeries. Thus, patients with osteoporosis require special planning considerations, including adequate preoperative evaluation and optimization. Surgical strategies aim towards maximizing screw pull-out strength, toggle resistance, as well as primary and secondary construct stability. Conclusions As osteoporosis plays a crucial role in the fate of patients undergoing spine surgery, surgeons need to be aware of the specific implications of low BMD. While there still is no consensus on the best course of treatment, multidisciplinary preoperative assessment and adherence to specific surgical principles help reduce the rate of implant-related complications.

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Sacral Insufficiency Fracture Following Short-Segment Lumbosacral Fusion: Case Series and Review of the Literature

Cited by 6 publications

References 54 publications

Superiority of MRI for Evaluation of Sacral Insufficiency Fracture

Superiority of MRI for Evaluation of Sacral Insufficiency Fracture

A Technical Nuance to Avoid Lumbar Five Radiculopathy with Anterior Lumbar Fusion and Posterior Instrumentation

Avoiding Spinal Implant Failures in Osteoporotic Patients: A Narrative Review

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