Four cases of bilateral pedicle fractures in the elderly

Abstract

Osteoporotic vertebral body fracture is common in the elderly population.

Pedicle fracture is rare, however. Several studies have reported that pedicle stress fractures are associated with stress-related predisposing factors such as athletic activity, spondylolysis, previous spinal surgery and osteoporosis.

We report here 4 cases of bilateral pedicle fractures in patients aged > 70 years. Three of these fractures were detected at L4 and the other at L3 level. All patients presented with low back pain and lower extremity numbness or pain. MRI revealed lumbar spinal canal stenosis adjacent to the pedicle fracture. Three patients underwent decompressive laminectomy and posterior fusion with pedicle screw fixation. Symptoms improved after surgery and follow up CT showed evidence of pedicle fracture healing in 2 of the 3 patients.

Osteoporosis was present in all 4 patients and bisphosphonate therapy was ongoing. There was no episode of major trauma that may have caused the pedicle fractures. Similar to previous reports, these fractures may be linked to stress fractures.