title: Sacral stress fracture after lumbar and lumbosacral fusion. How to manage it? A proposition based on three cases and literature review.
abstract: Sacral fracture after lumbosacral instrumentation could be a source of prolonged pain and a late autonomy recovery in old patients. Diagnosis remains difficult and usually delayed. No clear consensus for efficient treatment of this complication has been defined. Aim of this study was to determine how to manage them. Three patients who sustained sacral fracture after instrumented lumbosacral fusion performed for degenerative disease of the spine are discussed. History, physical examinations' findings and radiographic features are presented. Pertinent literature was analyzed. All patients complained of unspecific low back and buttock pain a few weeks after index surgery. Diagnosis was done on CT-scan. We always choose revision surgery with good functional results. Sacral stress fracture has to be reminded behind unspecific buttock or low back pain. CT-scan seems to be the best radiological test to do the diagnosis. Surgical treatment is recommended when lumbar lordosis and pelvic incidence mismatched.
authors.affiliation: Department of Reconstructive and Orthopaedic Surgery, Université René-Descartes, European Hospital Georges-Pompidou, AP-HP, 20, rue Leblanc, 75015 Paris, France. Electronic address: scemamacaroline@gmail.com.
authors.forename: C
authors.initials: C
authors.lastname: Scemama
authors.affiliation: Department of Reconstructive and Orthopaedic Surgery, Université René-Descartes, European Hospital Georges-Pompidou, AP-HP, 20, rue Leblanc, 75015 Paris, France. Electronic address: h.dastorg@gmail.com.
authors.forename: H
authors.initials: H
authors.lastname: D'astorg
authors.affiliation: Department of Reconstructive and Orthopaedic Surgery, Université René-Descartes, European Hospital Georges-Pompidou, AP-HP, 20, rue Leblanc, 75015 Paris, France. Electronic address: pierre.guigui@aphp.fr.
authors.forename: P
authors.initials: P
authors.lastname: Guigui
mesh_terms: D000368:Aged; D005260:Female; D015775:Fractures, Stress / Q000000981:diagnostic imaging / Q000209:etiology / Q000601:surgery*; D006801:Humans; D017116:Low Back Pain / Q000209:etiology; D008159:Lumbar Vertebrae / Q000601:surgery; D008297:Male; D012086:Reoperation / Q000009:adverse effects; D012447:Sacrum / Q000293:injuries* / Q000601:surgery; D016103:Spinal Fractures / Q000000981:diagnostic imaging / Q000209:etiology / Q000601:surgery*; D013123:Spinal Fusion / Q000009:adverse effects*
keywords: Complication; Fusion; Lumbar; Sacral; Stress fracture