title: Sacral fractures after multi-segmental lumbosacral fusion: a series of four cases and systematic review of literature.
abstract: Spine surgeons are becoming increasingly aware of sacral insufficiency fractures as a complication after lumbosacral fusions. We present four patients who suffered from sacral fractures after multi-segmental posterior lumbosacral fusion together with a systematic review of the literature that yielded six papers reporting on 12 cases. Summarizing these 16 cases, the typical patient suffering from this complication is a female, elderly individual [66.4 +/- 12.3 (mean +/- SD) years of age, 95% confidence interval 57.89-71] undergoing multilevel fusion of 4.9 +/- 3.4 (95% CI 3.1-6.8) segments. Due to nonspecific clinical complaints and inconclusive imaging there has been a median delay in diagnosis of 5 (IQR 3-6, range 1-49) weeks after onset of pain. It remains unclear whether this complication is rare or rather under-diagnosed. Fortunately, these fractures are predominantly benign conditions that respond well to conservative management in the majority of cases, depending on location.
authors.affiliation: Department of Orthopedic Surgery, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria.
authors.forename: Patrick
authors.initials: P
authors.lastname: Vavken
authors.forename: Petra
authors.initials: P
authors.lastname: Krepler
mesh_terms: D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D001416:Back Pain / Q000209:etiology; D001915:Braces; D015984:Causality; D005260:Female; D006801:Humans; D016268:Internal Fixators / Q000009:adverse effects; D008159:Lumbar Vertebrae / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery*; D008297:Male; D015663:Osteoporosis, Postmenopausal / Q000150:complications; D011183:Postoperative Complications / Q000209:etiology* / Q000473:pathology / Q000503:physiopathology; D016059:Range of Motion, Articular / Q000502:physiology; D012447:Sacrum / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery*; D012737:Sex Factors; D016103:Spinal Fractures / Q000000981:diagnostic imaging / Q000209:etiology* / Q000473:pathology; D013123:Spinal Fusion / Q000009:adverse effects*; D013314:Stress, Mechanical; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome