Bilateral pedicle stress fractures in a female athlete: case report and review of the literature.

Abstract

Clinical case report of bilateral stress fractures of the pedicle in a female athlete presenting with back pain. To report this unusual case and surgical treatment and to review the relevant literature. Low back pain is a frequent complaint in athletes, with the majority of cases being related to muscular or soft tissue etiology. Spondylolysis, or pars fracture, is the most common injury of the neural arch. Stress fracture of the pedicle is a much less common occurrence. Bilateral pedicle fractures in an otherwise healthy athlete has not been previously reported in the orthopedic literature. A 19-year-old female athlete presented with low back pain limiting sports and daily activities. Radiographic workup revealed bilateral stress fractures of the pedicles of the L5 vertebra. Circumferential fusion of the L5-S1 segment was performed after failure of conservative treatment. Anterior interbody structural allograft and a vertical mesh cage were combined with instrumented posterolateral fusion using segmental pedicle screws and autogenous iliac crest bone graft. The patient achieved complete pain relief, solid fusion, and return to normal function. In this uncommon case of bilateral stress fractures of the pedicle, circumferential fusion assures full immobilization of the injured motion segment and assures a high probability of successful healing.