title: A rare case of non-traumatic, multi-level, bilateral pedicle fractures of the lumbar spine in a 60-year-old patient.
abstract: We report a 60-year-old patient who sustained non-traumatic, multi-level, bilateral lumbar pedicle fractures in the setting of unilateral lumbar spondylolysis. A possible fracture mechanism is evaluated and a review of the literature is presented. Whereas contralateral pedicle fractures of lumbar vertebrae with unilateral spondylosis are well described in young athletes, there is only one case report of multi-level, bilateral pedicle fractures of the lumbar spine in a young patient who sustained a high-impact motorcycle accident. To our knowledge, this is the first report of multi-level, bilateral pedicular fractures of the lumbar spine without a history of trauma.
  
  
  
  The clinical case of a 60-year-old patient with lumbar pain radiating in both legs without antecedent trauma is presented. Besides an idiopathic primary adrenal failure, no further co-morbidities existed. Radiologic investigations showed acute bilateral pedicles' fractures of the lumbar vertebrae two to four (L2-4) and a unilateral spondylolysis L4-5. Dorsoventral instrumentation from L1 to L5 was performed in two steps.
  
  
  
  The patient had no neurological deficits at discharge. Perioperative cortisol substitution was arranged and continued in the course. At final follow-up after 6 years the patient was pain-free and radiographs confirmed complete fusion of L1-5 with mild degeneration of the adjacent segments.
  
  
  
  The presented fracture pattern has not been described to date. Because of multi-level involvement, instability requiring operative stabilisation was presumed and confirmed during surgery.
authors.affiliation: Department of Orthopaedic Surgery, Inselspital, Bern University Hospital, Bern, Switzerland. timo.schmid@insel.ch.
authors.forename: Timo
authors.identifier: 0000-0002-1773-7418
authors.initials: T
authors.lastname: Schmid
authors.affiliation: Orthopaedie Sonnenhof, Sonnenhofspital, Bern, Switzerland.
authors.forename: Paul
authors.initials: P
authors.lastname: Heini
authors.affiliation: Department of Orthopaedic Surgery, Inselspital, Bern University Hospital, Bern, Switzerland.
authors.forename: Lorin
authors.initials: L
authors.lastname: Benneker
mesh_terms: D005260:Female; D015775:Fractures, Stress / Q000000981:diagnostic imaging / Q000209:etiology* / Q000601:surgery; D006801:Humans; D017116:Low Back Pain / Q000000981:diagnostic imaging / Q000209:etiology / Q000601:surgery; D008159:Lumbar Vertebrae / Q000000981:diagnostic imaging / Q000293:injuries* / Q000601:surgery; D008279:Magnetic Resonance Imaging; D008875:Middle Aged; D011859:Radiography; D016103:Spinal Fractures / Q000000981:diagnostic imaging / Q000209:etiology* / Q000601:surgery; D013123:Spinal Fusion / Q000379:methods; D013169:Spondylolysis / Q000150:complications / Q000000981:diagnostic imaging / Q000601:surgery; D014057:Tomography, X-Ray Computed
keywords: Fracture; Lumbar spine; Pedicle fracture; Spine; Stress fracture