title: Misdiagnosis of sacral stress fracture: an underestimated cause of low back pain in pregnancy?
abstract: BACKGROUND
  Sacral stress fracture during pregnancy is an uncommon condition with unclear pathophysiology, presenting with non-specific symptoms and clinical findings. To date, few cases have been published in the literature describing the occurrence of sacral stress fracture during pregnancy.
  
  
  METHODS
  We report a 28-year-old primigravid patient who developed lumbosacral pain at the end of the second trimester. Symptoms were overlooked throughout pregnancy and the postpartum period, resulting in the development of secondary chronic gait and balance problems.
  
  
  CONCLUSIONS
  Stress fracture of the sacrum should be included in the differential diagnosis of low back and sacral pain during pregnancy. Its prevalence is probably underestimated because of the lack of specificity of the symptoms. Plain radiographs are not appropriate due to radiation exclusion; magnetic resonance is the only method that can be applied safely. There is limited information on natural history but many patients are expected to have a benign course. However, misdiagnosis may lead to prolonged morbidity and the development of secondary gait abnormalities. Stress fracture of the sacrum should be included in the differential diagnosis of low back and sacral pain during pregnancy. A high index of suspicion is necessary to establish an early diagnosis and appropriate treatment.
authors: Department of Occupational Medicine, Fundación Jiménez Díaz University Hospital, Madrid, Spain.
authors: Ambar
authors: A
authors: Deschamps Perdomo
authors: Department of Orthopaedic and Spine Surgery, Fundación Jiménez Díaz University Hospital, Madrid, Spain.
authors: Felix
authors: F
authors: Tome-Bermejo
authors: Department of Orthopaedic and Spine Surgery, Fundación Jiménez Díaz University Hospital, Madrid, Spain.
authors: Angel R
authors: AR
authors: Piñera
authors: Department of Orthopaedic and Spine Surgery, Fundación Jiménez Díaz University Hospital, Madrid, Spain.
authors: Luis
authors: L
authors: Alvarez
mesh_terms: D000328:Adult; D003937:Diagnosis, Differential; D003951:Diagnostic Errors; D005260:Female; D015775:Fractures, Stress / Q000150:complications* / Q000175:diagnosis; D006801:Humans; D017116:Low Back Pain / Q000175:diagnosis / Q000209:etiology*; D008279:Magnetic Resonance Imaging; D011247:Pregnancy; D011248:Pregnancy Complications; D012447:Sacrum / Q000293:injuries*; D016103:Spinal Fractures / Q000150:complications* / Q000175:diagnosis
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