Instrumented Lumbosacral Fusion Research Articles

Early Sacral Stress Fracture after Reduction of Spondylolisthesis and Lumbosacral Fixation: Case Report

Early sacral fracture is an extremely rare complication of instrumented lumbosacral fusion seen in older, osteopenic women. Previous reports have attributed the problem to the use of multisegmental (three or more levels) fixation, with the transfer of stress forces from rigid spinal implants to the sacrum. We report the only case, to the best of our knowledge, of early sacral fracture after a two-level lumbosacral fusion and the only case of early sacral fracture after reduction of spondylolisthesis. A patient presented with a sudden recurrence of low back and buttock pain a few days after lumbosacral decompression, reduction of L5-S1 Grade II spondylolisthesis, and instrumented L5-S1 fusion, including posterior lumbar interbody fusion. A transverse sacral fracture was found on plain x-rays 4 weeks later. Symptoms improved with brace therapy and medical treatment for osteoporosis. Early sacral fracture is a rare cause of pain after instrumented lumbosacral fusion. Although the transfer of loads from rigid spinal implants to adjacent segments is particularly problematic for multisegmental fusions, patients with short-segment constructs may also be affected. Active reduction of spondylolisthesis may provide additional adjacent segment stress contributing to this complication.

Early Fracture of the Sacrum or Pelvis

A retrospective review of a series of cases with a complication of instrumented lumbosacral fusion. To present a previously undescribed complication, early sacral or pelvic stress fracture, after instrumented lumbosacral fusion and to identify the risk factors associated with this complication. There are a number of well-described complications of instrumented lumbosacral fusion, including delayed stress fracture of the pelvis. Early sacral or pelvic stress fracture after instrumented lumbosacral fusion has not been previously reported, to the authors' knowledge. The authors present three cases of early stress fracture occurring at 2-4 weeks after surgery in patients who underwent instrumented multilevel lumbosacral fusions for degenerative lumbosacral disease. Two patients had sacral fracture, which to the authors' knowledge, has not been previously reported. Risk factors included lumbosacral instrumentation and fusion, osteoporosis in elderly women, and iliac crest bone graft procurement. All patients were treated conservatively, with restricted ambulation and gradual return to activity. This complication can cause significant morbidity and a delay in the patient's return to function. A better understanding of the related biomechanical forces and preoperative risk factors may identify patients at risk and may aid in surgical planning and in expectations of postoperative recovery.

Cigarette smoking effect on instrumented lumbosacral fusion: Abraham Rogozinski, MD (Rogozinski Orthopedic Clinic, Jacksonville, FL); Chaim Rogozinski, MD; Howard B. Weiss, DO

Cigarette smoking effect on instrumented lumbosacral fusion: Abraham Rogozinski, MD (Rogozinski Orthopedic Clinic, Jacksonville, FL); Chaim Rogozinski, MD; Howard B. Weiss, DO