Sacral Fracture after Posterior Screw Fixation: A Case Report

Abstract

Sacral fractures and failures are possible complication of instrumented lumbosacral arthrodesis. And it has received increasing attention in the surgical literature. It is sometimes difficult to diagnose the fractures and make timely treatment. It is helpful that preoperative awareness of risk factors involved sacral fracture and spinopelvic parameters in making plan of treatment and prevention of postoperative complication. There are many possible complications after posterior screw fixation, such as neurological or vascular injury, loss of curve correction, intraoperative pedicle fracture or loosening, dura injury, deep infection, and pseudarthrosis. But sacral fracture, distal part of lumbosacral arthrodesis is not common case. In this paper, we describe a case of sacral fracture of distal level of fixed vertebral body after lumbosacral arthrodesis in old aged woman and assessment of risk factors. The patient had herniated nucleus pulposus at L5/S1 level, and discectomy is operated. After operation, the symptom has relieved, but 1-year later other symptoms recurred radiating pain on both leg and back pain due to bilateral foraminal stenosis and central stenosis. So, lumbosacral arthrodesis and posterior screw fixation to L4-5-S1 levels are operated. Finally, the symptoms are resolved, but after spine fusion operation 1-month, it was found that sacral fracture of S1 vertebral body, distal part of spine fixation. The conservative treatment is chosen, and there is no aggravation of dislocation or deformity in follow-up exam. If the deformity aggravates, we make plan to surgery, extension of screw fixation to iliac bone. Key Words: Adult spine deformity; Malnutrition; Posterior spine arthrodesis; Sacral fracture