Sacral Insufficiency Fractures Presenting as Acute Low-Back Pain

Leroux, Jean Louis; Denat, Bruno; Thomas, E; Blotman, F; Bonnel, F.

doi:10.1097/00007632-199312000-00020

Cited by 71 publications

(42 citation statements)

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“…11,19,20 In line with previous reports, the most commonly observed fracture site was the sacrum, corresponding to the site of transfer of forces from the vertebral column to the pelvis. 20,21 The morphology of stress fractures (either radiation induced or due to bone insufficiency) is characteristic, with a generally symmetrical (H-shaped) appearance, with no mass effect. 22 On MRI, stress fractures present an easily recognizable oedema signal in contrast to metastases that disorganize the bone and form a real replacement tissue.…”

Section: Discussionmentioning

confidence: 99%

Pelvic insufficiency fracture (PIF) incidence in patients treated with intensity-modulated radiation therapy (IMRT) for gynaecological or anal cancer: single-institution experience and review of the literature

Bazire

Foy

et al. 2017

BJR

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Objective: To summarize the results of pelvic insufficiency fracture (PIF) incidence in patients with anal or gynaecological cancer treated by pelvic intensitymodulated radiation therapy (IMRT). Methods: The clinical and morphological (CT and/or pelvic MRI) characteristics of patients treated by IMRT at our institution between 2007 and 2014 were analyzed. The global incidence of PIF after external beam radiotherapy and the impact of tumour site (gynaecological or anal cancer) were determined. A dosimetric study was then performed to compare patients with and without pelvic fracture. Results: 341 patients were treated by IMRT for gynaecological or anal cancer between 2007 and 2014. 15 patients experienced at least 1 pelvic fracture after external beam radiotherapy, corresponding to an overall incidence of 4.4%. Age and menopausal status were correlated with an increased fracture risk (p 5 0.0274 and p , 0.0001, respectively). The site of the primary tumour (gynaecological or anal canal) was not associated with an excess fracture risk. The median maximum dose received at the fracture site was 50.3 Gy (range: 40.8-68.4 Gy). Conclusion: The incidence of pelvic fracture after IMRT is low, but is higher after the age of 50 and in patients who are postmenopausal. Pre-treatment evaluation of bone density by bone densitometry and phosphorus-calcium assessment could be useful prior to the management of these patients. Advances in knowledge: Pelvic fractures are a frequent complication after radiotherapy. The influence of IMRT and clinical characteristics were evaluated in this study.

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Section: Discussionmentioning

confidence: 99%

Pelvic insufficiency fracture (PIF) incidence in patients treated with intensity-modulated radiation therapy (IMRT) for gynaecological or anal cancer: single-institution experience and review of the literature

Bazire

Foy

et al. 2017

BJR

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“…Since its first description in 1982 [23], insufficiency fractures of the sacrum remain an unsuspected, but not uncommon, cause of low back pain in an elderly population [8]. The diagnosis may be difficult for several reasons [8,20]. First, the findings on routine radiographs may be subtle and may be overlooked owing to the complex anatomy and overlying bowel shadow and calcification.…”

Section: Discussion and Treatmentmentioning

confidence: 99%

“…They have often been interpreted as normal, even retrospectively, in greater than ½ of the cases [15]. Stress fractures through cancellous bone, especially in an osteopenic skeleton, are difficult to detect [20]. Second, metastatic disease is often suspected based on the clinical and radiographic findings, especially in a patient with a known history of malignancy.…”

Section: Discussion and Treatmentmentioning

confidence: 99%

“…This distribution suggests the weight of the body transmitting through the spine to the pelvis may be at least partially responsible for the fracture [8]. The presence of additional fractures in the spine or pelvis (up to 80% and mostly in the pubis), especially with a history of local radiotherapy, helps confirm the pathologic process in the sacrum is indeed a fracture [4,5,8,11,20,27,36]. Bilateral or multiple pelvic fractures can result in delayed healing [4,5].…”

Section: Discussion and Treatmentmentioning

confidence: 99%

“…Bilateral or multiple pelvic fractures can result in delayed healing [4,5]. Bone scintigraphy is the most sensitive study and commonly shows an H-shaped increased uptake (Honda sign) in up to 45% of cases (although other patterns have also been described) [9,15,20,28,30,32]. CT, with proper window setting, further confirms and defines the fracture and excludes a destructive process [9].…”

Section: Discussion and Treatmentmentioning

confidence: 99%

See 2 more Smart Citations

Low Backache in a 70-year-old Woman

Maheshwari

Frank

Pitcher

et al. 2009

Clinical Orthopaedics &Amp; Related Research

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Sacral insufficiency fractures: an easily overlooked cause of back pain in elderly women

Grasland

Pouchot²,

Mathieu³

et al. 1996

Archives of Internal Medicine

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Sacral insufficiency fractures (SIF) that usually present as nonspecific pelvic or low back pain are often overlooked in the elderly. In a retrospective study conducted in a department of internal medicine, 16 patients with SIF were identified during a 6-year period. All patients were elderly women (mean age of 81 years) who presented with low back or pelvic pain. Radicular pain in the lower limb was common. Ten patients were bedridden. All 16 patients were osteopenic. Plain radiographs of the pelvis were nondiagnostic in 11 patients. Radionuclide bone scan showed a typical H-shaped pattern of increased uptake in 11 patients, and computed tomographic scan confirmed SIF (9/9 patients). With bed rest and analgesics, outcome was favorable in all patients. This study confirms the nonspecific presentation of SIF and the need to maintain a high index of clinical suspicion to make a prompt diagnosis and avoid unnecessary and sometimes invasive procedures.

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Sacral Insufficiency Fractures Presenting as Acute Low-Back Pain

Cited by 71 publications

References 0 publications

Pelvic insufficiency fracture (PIF) incidence in patients treated with intensity-modulated radiation therapy (IMRT) for gynaecological or anal cancer: single-institution experience and review of the literature

Pelvic insufficiency fracture (PIF) incidence in patients treated with intensity-modulated radiation therapy (IMRT) for gynaecological or anal cancer: single-institution experience and review of the literature

Low Backache in a 70-year-old Woman

Sacral insufficiency fractures: an easily overlooked cause of back pain in elderly women

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