Stress Fracture of the Pedicle After Extensive Decompression
Stress Fracture of the Pedicle After Extensive Decompression
Lumbar spinal stenosis can be effectively treated by performing an extensive ipsilateral spinal decompression, including a partial pediculotomy, and contralateral posterior bone fusion. Infrequently, complications can arise following radical decompression to alleviate symptoms of stenosis, and one such complication is a pedicle fracture. Three reports of pedicle fractures following extensive spinal decompression and contralateral posterior fusion are detailed. This complication is emphasized, and interventions are discussed.
Three patients presented with symptoms attributable to lumbar stenosis; they were initially treated with an ipsilateral decompression, achieved in part, through a partial pediculotomy followed by contralateral autologous bone fusion. Initially, all three patients improved postoperatively; however, they later developed neurological symptoms ipsilateral to the side of spinal decompression. Computerized tomography scanning demonstrated pedicle fractures on the decompressed side. This complication has not yet been reported in association with decompression and fusion for lumbar stenosis.
Two of the patients developed leg pain necessitating reoperation whereas the third experienced only mild transient symptoms. The fractured pedicle was removed in one patient; laminar and spinous process fusion was performed again. Another patient underwent a total laminectomy, removal of the fractured pedicle, and bilateral transverse process fusion. Reoperation yielded satisfactory outcomes. The third patient's symptoms resolved without intervention.
Pedicle fractures are a potential complication of extensive lumbar decompression and contralateral posterior fusion.Loading forces from the facets or transverse processes are possibly the cause of such fractures. Removal of the fractured pedicle, additional decompression, and enhanced bone fusion are recommended when the symptoms warrant surgical intervention.
Lumbar spinal stenosis is a compression of neural elements in the spinal canal; ipsilateral spinal decompression and contralateral bone fusion safely and effectively alleviate symptoms of stenosis. Recently, extensive spinal decompression techniques including a partial pediculotomy have been described and appear to yield favorable results in both the lumbar and cervical spine. These and other methods currently used to achieve an adequate lumbar decompression vary greatly and may engender complications and controversy. Complications associated with lumbar decompression include acute cauda equina compression, lumbar spinal instability (olisthesis), lumbar spine osteolysis, and spinal hypermobility. Whether or not spinal stabilization is needed in patients undergoing a limited spinal decompression is also a subject of much debate; fusion-related complications include infection, graft-site fatigue fracture, pseudarthrosis, and excessive scarring.
Pedicle fractures are commonly associated with trauma such as isolated C-2 laminar-pedicle hangman's fracture, unilateral spondylolysis and subsequent contralateral pedicle fracture, or pedicle screw/plate fixation complications. This is the first report of pedicle fractures in patients with stenosis who were surgically treated with extensive unilateral decompression achieved in part through a partial pediculotomy followed by a contralateral posterior autologous bone fusion.
Lumbar spinal stenosis can be effectively treated by performing an extensive ipsilateral spinal decompression, including a partial pediculotomy, and contralateral posterior bone fusion. Infrequently, complications can arise following radical decompression to alleviate symptoms of stenosis, and one such complication is a pedicle fracture. Three reports of pedicle fractures following extensive spinal decompression and contralateral posterior fusion are detailed. This complication is emphasized, and interventions are discussed.
Three patients presented with symptoms attributable to lumbar stenosis; they were initially treated with an ipsilateral decompression, achieved in part, through a partial pediculotomy followed by contralateral autologous bone fusion. Initially, all three patients improved postoperatively; however, they later developed neurological symptoms ipsilateral to the side of spinal decompression. Computerized tomography scanning demonstrated pedicle fractures on the decompressed side. This complication has not yet been reported in association with decompression and fusion for lumbar stenosis.
Two of the patients developed leg pain necessitating reoperation whereas the third experienced only mild transient symptoms. The fractured pedicle was removed in one patient; laminar and spinous process fusion was performed again. Another patient underwent a total laminectomy, removal of the fractured pedicle, and bilateral transverse process fusion. Reoperation yielded satisfactory outcomes. The third patient's symptoms resolved without intervention.
Pedicle fractures are a potential complication of extensive lumbar decompression and contralateral posterior fusion.Loading forces from the facets or transverse processes are possibly the cause of such fractures. Removal of the fractured pedicle, additional decompression, and enhanced bone fusion are recommended when the symptoms warrant surgical intervention.
Lumbar spinal stenosis is a compression of neural elements in the spinal canal; ipsilateral spinal decompression and contralateral bone fusion safely and effectively alleviate symptoms of stenosis. Recently, extensive spinal decompression techniques including a partial pediculotomy have been described and appear to yield favorable results in both the lumbar and cervical spine. These and other methods currently used to achieve an adequate lumbar decompression vary greatly and may engender complications and controversy. Complications associated with lumbar decompression include acute cauda equina compression, lumbar spinal instability (olisthesis), lumbar spine osteolysis, and spinal hypermobility. Whether or not spinal stabilization is needed in patients undergoing a limited spinal decompression is also a subject of much debate; fusion-related complications include infection, graft-site fatigue fracture, pseudarthrosis, and excessive scarring.
Pedicle fractures are commonly associated with trauma such as isolated C-2 laminar-pedicle hangman's fracture, unilateral spondylolysis and subsequent contralateral pedicle fracture, or pedicle screw/plate fixation complications. This is the first report of pedicle fractures in patients with stenosis who were surgically treated with extensive unilateral decompression achieved in part through a partial pediculotomy followed by a contralateral posterior autologous bone fusion.