title: Bilateral pars fractures complicating long fusion to L5 in a patient with rheumatoid arthritis.
abstract: METHODS
  Case report.
  
  
  OBJECTIVE
  To report bilateral pars fractures at L5 complicating a long fusion for adult idiopathic scoliosis in a patient with rheumatoid arthritis.
  
  
  BACKGROUND
  To our knowledge, there are no reports in the literature regarding bilateral pars fractures at the end instrumented vertebrae of a long fusion at the lumbosacral junction, nor reports that have evaluated long spinal deformity corrections in patients with rheumatoid arthritis. The question of ending a long fusion at L5 or S1 is controversial, and a review is presented.
  
  
  METHODS
  We present the patient's history, physical examination, and radiographic findings; describe the surgical treatment and long-term follow-up; and provide a literature review.
  
  
  RESULTS
  Bilateral pars fractures at the end instrumented vertebrae of a long construct (T4-L5) that we discovered were subsequently revised by extension of the fusion to the sacrum. Anterior structural support at L5-S1 was also provided. At the latest follow-up (46 months), the patient has had no recurrence of her symptoms. Her radiographs showed a stable construct without loss of alignment in the sagittal or coronal planes. Her rheumatoid arthritis continues to be treated with biologic, disease-modifying antirheumatic drugs.
  
  
  CONCLUSIONS
  To our knowledge, this is the first report of the treatment and long-term outcome of a patient with rheumatoid arthritis and bilateral pars fractures at the end instrumented vertebrae (L5) of a long deformity correction construct.
authors.affiliation: Department of Orthopaedic Surgery, The Johns Hopkins Hospital, Baltimore, MD, USA.
authors.forename: Addisu
authors.initials: A
authors.lastname: Mesfin
authors.forename: Mesfin A
authors.initials: MA
authors.lastname: Lemma
mesh_terms: D018501:Antirheumatic Agents / Q000627:therapeutic use; D001172:Arthritis, Rheumatoid / Q000150:complications* / Q000188:drug therapy; D005260:Female; D006801:Humans; D008159:Lumbar Vertebrae / Q000000981:diagnostic imaging / Q000601:surgery*; D008875:Middle Aged; D010147:Pain Measurement; D010149:Postoperative Pain / Q000209:etiology; D011859:Radiography; D012086:Reoperation; D012447:Sacrum / Q000000981:diagnostic imaging / Q000293:injuries* / Q000601:surgery; D012600:Scoliosis / Q000150:complications / Q000000981:diagnostic imaging / Q000601:surgery*; D016103:Spinal Fractures / Q000000981:diagnostic imaging / Q000209:etiology* / Q000601:surgery; D013123:Spinal Fusion / Q000009:adverse effects* / Q000295:instrumentation; D013904:Thoracic Vertebrae / Q000000981:diagnostic imaging / Q000601:surgery*; D016896:Treatment Outcome
chemical_list: D018501:Antirheumatic Agents