Bilateral pedicle stress fracture in a patient with lumbar spinal stenosis: a case report.
METHODS
A case of bilateral pedicle stress fracture in a patient with lumbar spinal stenosis is reported, and the literature is reviewed.


OBJECTIVE
To report a rare case of bilateral pedicle stress fracture without a history of major trauma or surgery.


BACKGROUND
Bilateral pedicle fracture is a rare entity and few cases have been reported in the literature. All the reported cases had some underlying causative factors like previous spine surgery or stress-related activities. To the best of the authors' knowledge, only 1 case of bilateral pedicle stress fracture without a history of trauma, previous spine surgery, or stress-related activities has been reported.


METHODS
A 57-year-old man presented with low back pain and radiating pain in left leg that was exacerbated after walking. Plain radiograph showed severe degenerative changes at L4-5 level. Magnetic resonance imaging revealed lumbar spinal stenosis at L2-3, 3-4, and 4-5 levels. A computed tomography demonstrated bilateral L4 pedicle stress fracture. The patient was treated with decompressive laminectomies of L3-5, followed by posterior spinal fusion with rigid pedicle screw fixation and autogenous bone graft mixed with hydroxyapatite.


RESULTS
The patient achieved pain relief and returned to normal activity.


CONCLUSIONS
Stress fracture of the pedicle within the proximal vertebra of a severely degenerated lumbar spine is an uncommon entity. It may, however, be an additional source of symptoms in patients with lumbar spinal stenosis who present with further back pain. Surgeons caring for this group of patients should be aware of this condition.
Doita
Minoru
M
Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, Kobe, Japan. doita@med.kobe-u.ac.jp
Shimomura
Takatoshi
T
Nishida
Kotaro
K
Maeno
Koichiro
K
Fujioka
Hiroyuki
H
Kurosaka
Masahiro
M
D019299:Decompression, Surgical; D015775:Fractures, Stress / Q000175:diagnosis* / Q000601:surgery*; D006801:Humans; D007796:Laminectomy; D008159:Lumbar Vertebrae / Q000293:injuries* / Q000601:surgery; D008297:Male; D008875:Middle Aged; D016103:Spinal Fractures / Q000175:diagnosis* / Q000601:surgery*; D013130:Spinal Stenosis / Q000175:diagnosis* / Q000601:surgery*; D016896:Treatment Outcome