Abstract
IntroductionOsteoporosis is a common secondary complication of spinal cord injury, with fragility fractures typically occurring in the lower body and management often is conservative.Case presentationWe present a 52-year-old male with chronic complete tetraplegia who presented to the emergency room with unremitting autonomic dysreflexia (AD). He was admitted for medical management of the AD when a source of the AD could not be identified. After an extensive workup, the patient was found to have bilateral sacral insufficiency fractures. He subsequently underwent sacroplasty with immediate and full resolution of AD symptoms and return to full premorbid function within 24 h.DiscussionPeople with chronic spinal cord injury (SCI) are at risk for spinal column fragility fractures in addition to lower extremity fractures. Vertebroplasty may be a safe option for treatment of insufficiency fractures in situations where conservative care may put people at risk for significant immobility-associated complications.
Highlights
Osteoporosis is a common secondary complication of spinal cord injury, with fragility fractures typically occurring in the lower body and management often is conservative
We present for the first time a case of pathologic bilateral sacral insufficiency fractures causing intractable autonomic dysreflexia (AD) and loss of mobility
AD in an individual with chronic tetraplegia with sacroplasty resulting in immediate resolution of AD and return to premorbid function without complication
Summary
AD in an individual with chronic tetraplegia with sacroplasty resulting in immediate resolution of AD and return to premorbid function without complication. The occurrence of lower body long bone fractures in individuals with chronic SCI has been well documented, in this case we present a patient with fragility fractures to the sacrum This became the source of dangerous episodes of intractable AD which led to a prolonged hospital course for the patient. Management is often conservative, putting individuals with SCI at increased risk for complications associated with prolonged bed rest including pressure injuries, bowel dysfunction, deep vein thrombosis, contractures, and respiratory dysfunction [6] In this case, the complications associated with prolonged bedrest were avoided with immediate resolution of AD after sacroplasty without surgical complications. Immediate resolution of AD and prevention of complications associated with prolonged bed rest with quick return to prior functional status are significant indications for the use of minimally invasive procedures for the treatment of spinal column fragility fractures in the SCI population. Multidisciplinary collaboration of health care providers is integral to positive outcomes for patients with SCI
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