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Bilateral pedicle stress fracture in the lumbar spine of a sedentary office worker.
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MedLine Citation:
PMID:  16896839     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
A case of bilateral pedicle fracture in the lumbar spine of a sedentary office worker is being presented. No such case has been reported in the literature previously. Bilateral pedicle fracture is a rare entity. Few cases have been reported in literature. All the reported cases had some underlying causative factors like degenerative spine disease, previous spinal surgery or stress-related activities, e.g. athletes. Our case is a 36-year-old sedentary office worker with none of the factors mentioned. We present a case of a 36-year-old sedentary worker with long-standing low backache. There were no root tension signs. Plain radiographs were inconclusive. The patient had a CT scan. The CT scan revealed long-standing defects in the pedicles of L2 vertebra with pseudoarthrosis. Infiltration with anaesthetic relieved the symptoms. Our patient was managed conservatively with spine rehabilitation physiotherapy program. Pedicle fracture can develop due to abnormal stresses in the pedicle either because of previous spinal surgery or spondylitic changes in the spine. Bilateral pedicle fracture in the absence of these conditions is extremely rare.
Authors:
M Z Sadiq
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Publication Detail:
Type:  Journal Article     Date:  2006-08-02
Journal Detail:
Title:  European spine journal : official publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society     Volume:  15 Suppl 5     ISSN:  1432-0932     ISO Abbreviation:  Eur Spine J     Publication Date:  2006 Oct 
Date Detail:
Created Date:  2006-10-12     Completed Date:  2008-01-23     Revised Date:  2009-11-18    
Medline Journal Info:
Nlm Unique ID:  9301980     Medline TA:  Eur Spine J     Country:  Germany    
Other Details:
Languages:  eng     Pagination:  653-5     Citation Subset:  IM    
Affiliation:
Milton Keynes General Hospital, Milton Keynes, MK6 5LD, UK. docjb@hotmail.com
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MeSH Terms
Descriptor/Qualifier:
Adult
Back Pain / etiology*
Chronic Disease
Female
Fractures, Stress / complications*,  radiography,  therapy
Humans
Life Style*
Lumbar Vertebrae / injuries*,  radiography
Physical Therapy Modalities
Pseudarthrosis / complications*,  radiography,  therapy
Tomography, X-Ray Computed
Comments/Corrections

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

Full Text
Journal Information
Journal ID (nlm-ta): Eur Spine J
ISSN: 0940-6719
ISSN: 1432-0932
Publisher: Springer-Verlag, Berlin/Heidelberg
Article Information
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© Springer-Verlag 2006
Received Day: 4 Month: 4 Year: 2006
Revision Received Day: 8 Month: 6 Year: 2006
Accepted Day: 22 Month: 6 Year: 2006
Electronic publication date: Day: 2 Month: 8 Year: 2006
Print publication date: Month: 10 Year: 2006
Volume: 15 Issue: Suppl 5
First Page: 653 Last Page: 655
ID: 1602200
PubMed Id: 16896839
Publisher Id: 184
DOI: 10.1007/s00586-006-0184-y
issue-copyright-statement: © Springer-Verlag 2006

Bilateral pedicle stress fracture in the lumbar spine of a sedentary office worker
M. Z. Sadiq12 Address: docjb@hotmail.com
1Milton Keynes General Hospital, Milton Keynes, MK6 5LD UK
216 Malton Close, Monkston, Milton Keynes, MK10 9HR UK

Introduction

Isolated pedicle fracture in the spine is uncommon. It has been reported in association with previous spine surgery, or in highly active athletic individuals. We report a case of bilateral pedicle fracture in a patient with chronic backache without the history of trauma or any of the above-mentioned conditions. The patient was a sedentary worker with minimal physical demands.


Case report

We present a case of a 36-year-old female with a history of chronic backache. Her symptoms were of mild to moderate in intensity. Discomfort was mainly related to activity but she was performing her normal duties as an office manager without significant problems. On examination there were no neurological deficit or root tension signs. Plain radiographs were inconclusive. Clinical examination revealed localized deep tenderness at L2; therefore, a CT scan was performed. The CT scan showed bilateral long-standing defects through the pedicles of 2nd lumbar vertebra with pseudoarthrosis and sclerosis (Fig. 1a, b). Infiltration with local anaesthetic, under the X-ray guidance, in the involved area relieved the symptoms. Surgical management was discussed with the patient, which was declined. The patient underwent spine rehabilitation physiotherapy program, which resulted in the improvement of the symptoms.


Discussion

Bilateral pedicle stress fracture in the spine is a rare finding. Traughber and Havlina [10] reported the first case of a bilateral pedicle stress fracture. Cyron et al. [2] demonstrated that the parsintereticularis is thought to be the weakest site in the neural arch, followed by the pedicle. In cases with established unilateral stress fracture, there is a redistribution of forces in the neural arch, which leads to compensatory sclerosis of contralateral bony structures. A compensatory hypertrophy of the contralateral pedicle has been documented [1, 8]. This entity was first described by Wilkinson and Hall [11] in 1974. These authors reported on seven patients whose radiographs were suspicious for a neoplastic process occurring in a pedicle (e.g. osteoid osteoma or osteoblastoma). Further investigation revealed unilateral spondylolysis with sclerosis of the contralateral posterior elements. The incidence of bilateral pedicle stress fracture is unknown in an otherwise normal spine. Gunzburg and Fraser [3] introduced the term pediculolysis in 1991 in a patient with multilevel facet joint osteoarthritis and minimal spondylolisthesis at L4–L5. Pedicle fracture has been reported in cases following posterolateral instrumented spinal fusion [4, 5, 7]. Bilateral pedicle stress fractures or pediculolysis have been documented in an athlete of high physical demand [6]. Stanley and Smith [9] reported a case of pedicle fracture following laminectomy. In our patient the fractures appear to be old with evidence of sclerosis at the fracture margins along with pseudoarthrosis. This type of bilateral pedicle stress fracture has not been documented in a normal spine of a sedentary office worker without a history of major trauma or surgery.


Conclusion

Pedicle fracture is uncommon but has been reported in association with degenerative spondylolisthesis, unilateral spondylolysis, following spinal surgery but not in an otherwise normal spine. Pedicle stress fracture may show either as a recent fracture or may have signs of established pseudoarthrosis. So far there is no case of bilateral pedicle stress fracture in an otherwise normal spine.


References
1.. Araki T,Harata S,Nakano K,Satoh T. Reactive sclerosis of the pedicle associated with contralateral spondylolysisSpine 1992;17:1424–1426. [doi: 10.1097/00007632-199211000-00028]
1.. Araki T, Harata S, Nakano K, Satoh T (1992) Reactive sclerosis of the pedicle associated with contralateral spondylolysis. Spine 17:1424–1426 [pmid: 1462223]
2.. Cyron BM,Hutton WC,Troup JDG. Spondylolytic fracturesJ Bone Joint Surg Br 1976;58:462–466.
2.. Cyron BM, Hutton WC, Troup JDG (1976) Spondylolytic fractures. J Bone Joint Surg Br 58:462–466 [pmid: 1018032]
3.. Gunzburg R,Fraser RD. Stress fracture of lumbar pedicle. Case reports of pediculolysis and review of literatureSpine 1991;16:185–189.
3.. Gunzburg R, Fraser RD (1991) Stress fracture of lumbar pedicle. Case reports of pediculolysis and review of literature. Spine 16:185–189 [pmid: 2011774]
4.. Ha KY,Kim YH. Bilateral pedicle stress fracture after instrumented posterolateral lumbar fusion: a case reportSpine 2003;28(8):E158–E160. [doi: 10.1097/00007632-200304150-00024]
4.. Ha KY, Kim YH (2003) Bilateral pedicle stress fracture after instrumented posterolateral lumbar fusion: a case report. Spine 28(8):E158–E160 [pmid: 12698135]
5.. Macdessi SJ,Leong AK,Bentivoglio JE. Pedicle fracture after instrumented posterolateral lumbar fusion: a case reportSpine 2001;26(5):580–582. [doi: 10.1097/00007632-200103010-00026]
5.. Macdessi SJ, Leong AK, Bentivoglio JE (2001) Pedicle fracture after instrumented posterolateral lumbar fusion: a case report Spine 26(5):580–582 [pmid: 11242389]
6.. Parvataneni HK,Nicholas SJ,McCance SE. Bilateral pedicle stress fractures in a female athlete: case report and review of the literatureSpine 2004;29(2):E19–E21. [doi: 10.1097/01.BRS.0000105988.43472.2B]
6.. Parvataneni HK, Nicholas SJ, McCance SE (2004) Bilateral pedicle stress fractures in a female athlete: case report and review of the literature. Spine 29(2):E19–E21 [pmid: 14722420]
7.. Robertson PA,Grobler LJ. Stress fracture of the pedicle A late complication of posterolateral fusionSpine 1993;18:930–932. [doi: 10.1097/00007632-199306000-00021]
7.. Robertson PA, Grobler LJ (1993) Stress fracture of the pedicle A late complication of posterolateral fusion. Spine 18:930–932 [pmid: 8316897]
8.. Sherman FC,Wilkinson RH,Hall JE. Reactive sclerosis of a pedicle and spondylolysis in the lumbar spineJ Bone Joint Surg Am 1977;59:49–54.
8.. Sherman FC, Wilkinson RH, Hall JE (1977) Reactive sclerosis of a pedicle and spondylolysis in the lumbar spine. J Bone Joint Surg Am 59:49–54 [pmid: 833174]
9.. Stanley D,Smith TW. Contralateral pedicle stress fracture. An unusual complication of laminectomySpine 1990;15:598–599.
9.. Stanley D, Smith TW (1990) Contralateral pedicle stress fracture. An unusual complication of laminectomy. Spine 15:598–599 [pmid: 2402702]
10.. Traughber PD,Havlina JM. Bilateral pedicle stress fractures: SPECT and CT featuresJ Comput Assist Tomogr 1991;15:338–340. [doi: 10.1097/00004728-199103000-00033]
10.. Traughber PD, Havlina JM Jr (1991) Bilateral pedicle stress fractures: SPECT and CT features J Comput Assist Tomogr 15:338–340 [pmid: 2002123]
11.. Wilkinson RH,Hall JE. The sclerotic pedicle: tumor or pseudotumor?Radiology 1974;111:683–688.
11.. Wilkinson RH, Hall JE (1974) The sclerotic pedicle: tumor or pseudotumor? Radiology 111:683–688 [pmid: 4829003]

Figures

[Figure ID: Fig1]
Fig. 1 

a CT scan of the vertebra showing bilateral pedicle fracture. b CT scan showing bilateral pedicle fracture with pseudoarthrosis



Article Categories:
  • Case Report

Keywords: Keywords Pedicle fracture, Stress fracture, Backache, Bilateral.

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