Timo Schmid1, Paul Heini2, Lorin Benneker3. 1. Department of Orthopaedic Surgery, Inselspital, Bern University Hospital, Bern, Switzerland. timo.schmid@insel.ch. 2. Orthopaedie Sonnenhof, Sonnenhofspital, Bern, Switzerland. 3. Department of Orthopaedic Surgery, Inselspital, Bern University Hospital, Bern, Switzerland.
Abstract
INTRODUCTION: We report a 60-year-old patient who sustained non-traumatic, multi-level, bilateral lumbar pedicle fractures in the setting of unilateral lumbar spondylolysis. A possible fracture mechanism is evaluated and a review of the literature is presented. Whereas contralateral pedicle fractures of lumbar vertebrae with unilateral spondylosis are well described in young athletes, there is only one case report of multi-level, bilateral pedicle fractures of the lumbar spine in a young patient who sustained a high-impact motorcycle accident. To our knowledge, this is the first report of multi-level, bilateral pedicular fractures of the lumbar spine without a history of trauma. METHODS: The clinical case of a 60-year-old patient with lumbar pain radiating in both legs without antecedent trauma is presented. Besides an idiopathic primary adrenal failure, no further co-morbidities existed. Radiologic investigations showed acute bilateral pedicles' fractures of the lumbar vertebrae two to four (L2-4) and a unilateral spondylolysis L4-5. Dorsoventral instrumentation from L1 to L5 was performed in two steps. RESULTS: The patient had no neurological deficits at discharge. Perioperative cortisol substitution was arranged and continued in the course. At final follow-up after 6 years the patient was pain-free and radiographs confirmed complete fusion of L1-5 with mild degeneration of the adjacent segments. CONCLUSION: The presented fracture pattern has not been described to date. Because of multi-level involvement, instability requiring operative stabilisation was presumed and confirmed during surgery.
INTRODUCTION: We report a 60-year-old patient who sustained non-traumatic, multi-level, bilateral lumbar pedicle fractures in the setting of unilateral lumbar spondylolysis. A possible fracture mechanism is evaluated and a review of the literature is presented. Whereas contralateral pedicle fractures of lumbar vertebrae with unilateral spondylosis are well described in young athletes, there is only one case report of multi-level, bilateral pedicle fractures of the lumbar spine in a young patient who sustained a high-impact motorcycle accident. To our knowledge, this is the first report of multi-level, bilateral pedicular fractures of the lumbar spine without a history of trauma. METHODS: The clinical case of a 60-year-old patient with lumbar pain radiating in both legs without antecedent trauma is presented. Besides an idiopathic primary adrenal failure, no further co-morbidities existed. Radiologic investigations showed acute bilateral pedicles' fractures of the lumbar vertebrae two to four (L2-4) and a unilateral spondylolysis L4-5. Dorsoventral instrumentation from L1 to L5 was performed in two steps. RESULTS: The patient had no neurological deficits at discharge. Perioperative cortisol substitution was arranged and continued in the course. At final follow-up after 6 years the patient was pain-free and radiographs confirmed complete fusion of L1-5 with mild degeneration of the adjacent segments. CONCLUSION: The presented fracture pattern has not been described to date. Because of multi-level involvement, instability requiring operative stabilisation was presumed and confirmed during surgery.
Authors: Fernando Ruiz Santiago; Antonio Jesús Láinez Ramos-Bossini; Yì Xiáng J Wáng; José Pablo Martínez Barbero; Jade García Espinosa; Alberto Martínez Martínez Journal: Quant Imaging Med Surg Date: 2022-07