title: A novel technique to repair a transverse sacral fracture in a previously fused lumbosacral spondylolisthesis.
abstract: BACKGROUND
  Transverse fractures of the sacrum are rare, and surgical treatment for these fractures ranges from conservative to challenging. Transverse stress fractures of the sacrum after placement of lumbar-to-sacral instrumentation have been previously described. We report a new technique to repair a transverse Type-2 Roy-Camille fracture with spondylolisthesis of S1 over S2 in a previously fused instrumented high-grade L4-L5, L5-S1 spondylolisthesis.
  
  
  METHODS
  A 64-year-old female who previously had an L4-L5, L5-S1 fusion for spondylolisthesis presented with excruciating lower back pain and radiculopathy for over 6 months. She was found to have an S1-S2 transverse fracture caused by previous implantation of pedicle screws. She underwent repositioning of several failed right lumbar and sacral screws and then had bilateral S1-S2 screws placed directly across the fracture line. The patient had an unremarkable postoperative course. She discontinued most of her pain medications within 6 weeks postoperatively. In the months following surgery, she reported only minimal lower back pain and no radiculopathy with the last appointment 5 years postoperatively.
  
  
  CONCLUSIONS
  We describe a novel technique to reduce an iatrogenic transverse type-2 Roy-Camille fracture at S1-S2 in a previously instrumented high-grade L4-L5, L5-S1 spondylolisthesis. The patient's fracture achieved adequate reduction and fusion with symptomatic relief.
authors.affiliation: Department of Neurosurgery, Henry Ford Hospital, Detroit, Michigan, USA.
authors.forename: Thomas
authors.initials: T
authors.lastname: Noh
authors.affiliation: Department of Neurosurgery, Henry Ford Hospital, Detroit, Michigan, USA.
authors.forename: Mokbel K
authors.initials: MK
authors.lastname: Chedid
keywords: High-transverse Type-2 Roy-Camille fracture; L4-L5 spondylolisthesis; L5-S1 spondylolisthesis