An Atraumatic Sacral Fracture with Lumbosacral Radiculopathy Complicating the Early Postpartum Period: A Case Report

Abstract

Patient: Female, 26 Final Diagnosis: Atraumatic fatigue sacral fracture Symptoms: Lumbar back pain with radiculopathy Medication: — Clinical Procedure: — Specialty: General and Internal Medicine Objective: Rare disease Background: Sacral stress fractures are rare complications of pregnancy and the early postpartum. Of these, few present with lumbosacral radiculopathy. We report the first Australian case of a young multiparous woman who sustained an atraumatic, fatigue sacral fracture with associated radiculopathy. We highlight the diagnostic process and chronic management of this case, particularly in relation to a future pregnancy. Case Report: A 26-year-old multiparous Caucasian female presented with worsening lumbosacral back pain and radicular symptoms following the rapid and spontaneous vaginal delivery of her second infant. Her pregnancy was unremarkable and she had no personal risk factors for osteoporosis. A magnetic resonance imaging (MRI) scan confirmed the diagnosis of a right S1 vertebral fracture. Bone densitometry and fasting bone metabolic testing excluded pregnancy-associated osteoporosis. She was managed conservatively with intermittent bed rest, regular physiotherapy and multimodal analgesia. During a future pregnancy, she experienced a severe exacerbation of her lumbosacral radiculopathy requiring hospital admission, up-titration of her analgesia and a right S1 epidural injection. She subsequently underwent an elective caesarean section and has since benefitted from regular hydrotherapy. Conclusions: Lumbosacral radiculopathy in the absence of trauma during pregnancy or the early postpartum should prompt consideration of an underlying atraumatic, fatigue sacral fracture. Such fractures may result from the abnormal biomechanical loading of the sacrum during rapid vaginal deliveries and are most effectively diagnosed by MRI. Conservative management strategies involving physiotherapy and multimodal analgesia are recommended. Future pregnancies may exacerbate radicular symptoms. Such patients may subsequently benefit from elective caesarean section deliveries and hydrotherapy.

High prevalence of spondyloarthritis-like MRI lesions in postpartum women: a prospective analysis in relation to maternal, child and birth characteristics

“…34 Sacral fracture is considered to be a rare complication of giving birth. 35 Nonetheless, in this rather small study population, MRI detected two sacral fractures. The fractures were asymptomatic and giving birth was atraumatic and without complications, making these findings accidental.…”

Fracturas pélvicas por estrés relacionadas al embarazo

“…Las fracturas por fatiga suelen ocurrir en sujetos con actividades repetitivas de soporte de peso con aumento reciente de la intensidad y/o deficiencias dietéticas (3) . La tríada característica incluye la presencia de amenorrea, trastornos alimenticios y osteopenia, las cuales representan un papel importante en la aparición de fracturas pélvicas en mujeres (17) .…”

“…Las molestias pélvicas y lumbares durante el embarazo y puerperio son comunes debido a la relajación de los ligamentos / tejidos blandos y el traumatismo de los tejidos blandos (3) . La prevalencia de dolor lumbar en el período prenatal es cercana al 70% y la frecuencia de dolor pélvico relacionado al embarazo es 16% a 20% (21) .…”

“…Debido a sus características clínicas y radiológicas inespecíficas, a menudo el diagnóstico es omitido. Solo existen informes de alrededor de 10 casos de fracturas pélvicas por estrés durante el embarazo en la literatura (3) , de los cuales solo 2 casos han sido hallados antes del parto (4,5) .…”