Spontaneous osteoporotic fractures of the sacrum causing neurological damage. Report of three cases.

Although osteoporotic fractures of the sacrum seem to be a well-known entity, their associated rate of neurological complications has not been assessed in the literature. The authors report three such cases of nerve root compromise in elderly women and conduct a literature review. Based on their review, they estimate the incidence to be approximately 2%. The true incidence is probably higher because many case reports provide only scant information on symptoms; furthermore, sphincter dysfunction and lower-limb paresthesias are the most common symptoms and can readily be overlooked or misinterpreted in elderly patients with multiple health problems. The neurological manifestations were delayed in some cases. A full recovery is the rule. The characteristics of the sacral fracture are not consistently related with the risk of neurological compromise. In most reviewed cases the authors found no displacement and in many the foramina were not involved. The pathophysiology of the neurological manifestations remains unclear. The authors suggest that patients with sacral osteoporotic fractures should be carefully monitored for neurological manifestations.