Multi-level, bilateral pedicle fractures: case report

Abstract

Bilateral pedicle fracture is an extremely rare entity and few cases have been reported in literature. A case of bilateral multi-level pedicle fractures involving four lumbar vertebrae is being presented. Bilateral pedicle stress fracture at L1 -L4 was observed in a 61-year-old woman presented with low back pain. There was no any predisposing factor like trauma, spinal surgery, smoking or alcohol consumption except mild osteoporosis and bisphosphonate usage in the patient's medical history. We are unable to determine whether the fractures are related to osteoporosis or bisphosphonate therapy but these are the only remaining suspected reasons in the present case. Further studies are required to define the effect of bisphosphonates usage on vertebral segments.

Bisphosphonate-associated Atypical Fractures that are not “Atypical Femoral Fractures”

“…Long-term pamidronate in a young patient has been described in another report [42] as inducing an osteopetrotic state mimicking the characteristic bone-in-bone radiological sign. While no fractures are reported in that case, Whytes's patient's bilateral vertebral pedicle fractures have also been observed in three separate BP exposed individuals [43,44,45], respectively after 3 years of IV ibandronate, after 4 years of weekly alendronate, and after 10 years of risedronate. In addition, another atraumatic 3-level bilateral pedicle fracture in an elderly man, previously diagnosed two years before as osteoporotic, was reported in 2006.…”

Adjacent Bi-level bilateral pedicle stress fractures after instrumented posterolateral lumbar fusion—a case report and review of the literature

“…The biomechanical background of the pedicles, with increased strength and short moment arm than the pars, enables these structures to resist greater cyclic stress when force is transmitted through the vertebra [2]. These rare lesions can be related to trauma, activityrelated mechanical stress, altered bone biology or, most of the times, post-operative complications of spine instrumentation, mainly at the upper level of posterior fusion [3][4][5]. The authors report a case of bi-level adjacent bilateral pedicle fracture after a posterolateral L4-L5 fusion, which, to the best of our knowledge, has never been described, and we provide an explanation to this event in light with the current literature.…”

Two-level spontaneous pedicle fracture above a degenerative spondylolisthesis and minimally invasive treatment

“…Pedicle fractures have been noted to occur in several different populations of patients including young athletes,[ 1 ] sedentary office workers,[ 2 ] a 12-year-old patient,[ 3 ] middle-age females,[ 4 ] and an elderly patient during a massage. [ 5 ] Pedicle fracture has also been noted in postoperative laminectomy and lumbar fusion.…”