RESEARCH PROGRESS OF STRESS FRACTURE OF LUMBAR PEDICLE_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

LIU Yong , YIN Qudong , GU Sanjun , SUN Zhenzhong , RUI Yongjun , SHOU Kuishui.

Department of Orthopaedics, the 9th People’s Hospital of Wuxi, Wuxi Jiangsu, 214062, P.R.China. Corresponding author: YIN Qudong, E-mail: yinqudong@sina.com;

Corresponding author：

Keywords：

Stress fracture; Pedicle; Lumbar vertebra; Low back pain; Treatment

DOI：

10.7507/1002-1892.20130052

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Objective To review the research progress of stress fracture of the lumbar pedicle. Methods The literature about the stress fracture of the lumbar pedicle was reviewed extensively and summarized. Results There are two types of stress fracture: fatigue and structure insufficient. Stress fracture of lumbar pedicle occurred mainly in the crowd with repetitive and large activities of spine, contralateral spondylolysis, or previous surgery of lumbar vertebra. The main stresses causing stress fracture of the lumbar pedicle are shear stress and twisting stress, followed by sudden hyperflexion or hyperextension of the spine. Stress fracture of lumbar pedicle was easily missed by conventional X-ray examination, usually XCT, MRI, or bone scan was needed to confirm the diagnosis. It is divided into 4 types or 4 periods according to MRI findings: stress reaction, incomplete fracture, complete fracture, and pseudarthrosis. For patients with incomplete, complete, and juvenile stress fractures of the lumbar pedicle without nerve root irritation, the majority of claims preferred conservative treatment and the healing rate of fracture was high; for patients with bilateral pseudarthrosis and with nerve root irritation as well as patients who failed to the conservative treatment, surgical management was advocated and the operation result is good. Conclusion Stress fracture of the lumbar pedicle as one of the causes of low back pain is extremely rare, and is easily missed clinically. Surgery or conservative management should be selected based on type of fracture and specific condition of the patient, the treatment results are satisfactory.

Citation： LIU Yong,YIN Qudong,GU Sanjun,SUN Zhenzhong,RUI Yongjun,SHOU Kuishui.. RESEARCH PROGRESS OF STRESS FRACTURE OF LUMBAR PEDICLE. Chinese Journal of Reparative and Reconstructive Surgery, 2013, 27(2): 240-242. doi: 10.7507/1002-1892.20130052 Copy

1.	Garber JE, Wright AM. Unilateral spondylolysis with contralateral pedicle fracture. Spine (Phila Pa 1976), 1986, 11(1): 63-66.
2.	Stanley D, Smith TW. Contralateral pedicle stress fracture. An unusual complication of laminectomy. Spine (Phila Pa 1976), 1990, 15(5): 598-599.
3.	Gunzburg R, Fraser RD. Stress fracture of the lumbar pedicle. Case reports of “pediculolysis” and review of literature. Spine (Phila Pa 1976), 1991, 16(2): 185-189.
4.	Traughber PD, Havlina JM. Bilateral pedicle stress fractures: SPECT and CT features. J Comput Assist Tomogr, 1991, 15(2): 338-340.
5.	Weatherley CR, Mehdian H, Berghe LV. Low back pain with fracture of the pedicle and contralateral spondylolysis. A technique of surgical management. J Bone Joint Surg (Br), 1991, 73(6): 990-993.
6.	Araki T, Harata S, Nakano K, et al. Reactive sclerosis of the pedicle associated with contralateral spondylolysis. Spine (Phila Pa 1976), 1992, 17(11): 1424-1426.
7.	Robertson PA, Grobler LJ. Stress fracture of the pedicle. A late complication of posterolateral lumbar fusion. Spine (Phila Pa 1976), 1993, 18(7): 930-932.
8.	Macdessi SJ, Leong AK, Bentivoglio JE. Pedicle fracture after instrumented posterolateral lumbar fusion: a case report. Spine (Phila Pa 1976), 2001, 26(5): 580-582.
9.	Sheehan JP, Helm GA, Sheehan JM, et al. Stress fracture of the pedicle after extensive decompression and contralateral posterior fusion for lumbar stenosis. Report of three cases. Neurosurg Focus, 2002, 13(2): E9.
10.	Ha KY, Kim YH. Bilateral pedicle stress fracture after instrumented posterolateral lumbar fusion: a case report. Spine (Phila Pa 1976), 2003, 28(8): E158-160.
11.	Kim HS, Ju CI, Kim SW. Bilateral pedicle stress fracture accompanying spondylolysis in a patient with ankylosing spondylitis. J Korean Neurosurg Soc, 2010, 48(1): 70-72.
12.	Palmer DK, Inceoglu S, Cheng WK. Stem fracture after total facet replacement in the lumbar spine: a report of two cases and review of the literature. Spine J, 2011, 11(7): e15-19.
13.	Mathew P, Blackman M, Redla S, et al. Bilateral pedicle fractures following anterior dislocation of the polyethylene inlay of a ProDisc artificial disc replacement: a case report of an unusual complication. Spine (Phila Pa 1976), 2005, 30(11): E311-314.
14.	Parvataneni HK, Nicholas SJ, McCance SE. Bilateral pedicle stress fractures in a female athlete: case report and review of the literature. Spine (Phila Pa 1976), 2004, 29(2): E19-21.
15.	Sairyo K, Katoh S, Sasa T, et al. Athletes with unilateral spondylolysis are at risk of stress fracture at the contralateral pedicle and pars interarticularis: a clinical and biomechanical study. Am J Sports Med, 2005, 33(4): 583-590.
16.	Sadiq MZ. Bilateral pedicle stress fracture in the lumbar spine of a sedentary office worker. Eur Spine J, 2006, 15 Suppl 5: 653-655.
17.	Obid P, Richter A, Ubeyli H, et al. Spontane0us bilateral pedicle fracture 30 years after Harrington Instrumentation for idiopathic scoliosis: a case report. J Med Case Rep, 2012, 23, 6(1): 29.
18.	Sirvanci M, Ulusoy L, Duran C. Pedicular stress fracture in lumbar spine. Clin Imaging, 2002, 26(3): 187-193.
19.	Murthy NS. Imaging of stress fractures of the spine. Radiol Clin North Am, 2012, 50(4): 799-821.
20.	Doita M, Shimomura T, Nishida K, et al. Bilateral pedicle stress fracture in a patient with lumbar spinal stenosis: a case report. J Spinal Disord Tech, 2008, 21(7): 531-534.
21.	Ornetti P, Prati C, Fery-Blanco C, et al. Pedicle stress fracture: an unusual complication of pycnodysostosis. Clin Rheumatol, 2008, 27(3): 385-387.
22.	Doita M, Ando Y, Hirata S, et al. Bilateral pedicle stress fracture in a patient with osteoporotic compression fracture. Eur Spine J, 2009, 18(Suppl 2): 206-209.
23.	Jeong IH, Hwang EH, Bae WT. Contralateral Pedicular Fracture with Unilateral Spondylolysis. J Korean Neurosurg Soc, 2009, 46(6): 584-587.
24.	Amari R, Sakai T, Katoh S, et al. Fresh stress fractures of lumbar pedicles in an adolescent male ballet dancer: Case report and literature review. Arch Orthop Trauma Surg, 2009, 129(3): 397-401.
25.	Johnson JN, Wang MY. Stress fracture of the lumbar pedicle bilaterally: surgical repair using a percutaneous minimally invasive technique. J Neurosurg Spine, 2009, 11(6): 724-728.
26.	Hajjioui A, Khazzani H, Sbihi S, et al. Spondylolisthesis on bilateral pedicle stress fracture in the lumbar spine: a case study. Ann Phys Rehabil Med, 2011, 54(1): 53-58.

1. Garber JE, Wright AM. Unilateral spondylolysis with contralateral pedicle fracture. Spine (Phila Pa 1976), 1986, 11(1): 63-66.
2. Stanley D, Smith TW. Contralateral pedicle stress fracture. An unusual complication of laminectomy. Spine (Phila Pa 1976), 1990, 15(5): 598-599.
3. Gunzburg R, Fraser RD. Stress fracture of the lumbar pedicle. Case reports of “pediculolysis” and review of literature. Spine (Phila Pa 1976), 1991, 16(2): 185-189.
4. Traughber PD, Havlina JM. Bilateral pedicle stress fractures: SPECT and CT features. J Comput Assist Tomogr, 1991, 15(2): 338-340.
5. Weatherley CR, Mehdian H, Berghe LV. Low back pain with fracture of the pedicle and contralateral spondylolysis. A technique of surgical management. J Bone Joint Surg (Br), 1991, 73(6): 990-993.
6. Araki T, Harata S, Nakano K, et al. Reactive sclerosis of the pedicle associated with contralateral spondylolysis. Spine (Phila Pa 1976), 1992, 17(11): 1424-1426.
7. Robertson PA, Grobler LJ. Stress fracture of the pedicle. A late complication of posterolateral lumbar fusion. Spine (Phila Pa 1976), 1993, 18(7): 930-932.
8. Macdessi SJ, Leong AK, Bentivoglio JE. Pedicle fracture after instrumented posterolateral lumbar fusion: a case report. Spine (Phila Pa 1976), 2001, 26(5): 580-582.
9. Sheehan JP, Helm GA, Sheehan JM, et al. Stress fracture of the pedicle after extensive decompression and contralateral posterior fusion for lumbar stenosis. Report of three cases. Neurosurg Focus, 2002, 13(2): E9.
10. Ha KY, Kim YH. Bilateral pedicle stress fracture after instrumented posterolateral lumbar fusion: a case report. Spine (Phila Pa 1976), 2003, 28(8): E158-160.
11. Kim HS, Ju CI, Kim SW. Bilateral pedicle stress fracture accompanying spondylolysis in a patient with ankylosing spondylitis. J Korean Neurosurg Soc, 2010, 48(1): 70-72.
12. Palmer DK, Inceoglu S, Cheng WK. Stem fracture after total facet replacement in the lumbar spine: a report of two cases and review of the literature. Spine J, 2011, 11(7): e15-19.
13. Mathew P, Blackman M, Redla S, et al. Bilateral pedicle fractures following anterior dislocation of the polyethylene inlay of a ProDisc artificial disc replacement: a case report of an unusual complication. Spine (Phila Pa 1976), 2005, 30(11): E311-314.
14. Parvataneni HK, Nicholas SJ, McCance SE. Bilateral pedicle stress fractures in a female athlete: case report and review of the literature. Spine (Phila Pa 1976), 2004, 29(2): E19-21.
15. Sairyo K, Katoh S, Sasa T, et al. Athletes with unilateral spondylolysis are at risk of stress fracture at the contralateral pedicle and pars interarticularis: a clinical and biomechanical study. Am J Sports Med, 2005, 33(4): 583-590.
16. Sadiq MZ. Bilateral pedicle stress fracture in the lumbar spine of a sedentary office worker. Eur Spine J, 2006, 15 Suppl 5: 653-655.
17. Obid P, Richter A, Ubeyli H, et al. Spontane0us bilateral pedicle fracture 30 years after Harrington Instrumentation for idiopathic scoliosis: a case report. J Med Case Rep, 2012, 23, 6(1): 29.
18. Sirvanci M, Ulusoy L, Duran C. Pedicular stress fracture in lumbar spine. Clin Imaging, 2002, 26(3): 187-193.
19. Murthy NS. Imaging of stress fractures of the spine. Radiol Clin North Am, 2012, 50(4): 799-821.
20. Doita M, Shimomura T, Nishida K, et al. Bilateral pedicle stress fracture in a patient with lumbar spinal stenosis: a case report. J Spinal Disord Tech, 2008, 21(7): 531-534.
21. Ornetti P, Prati C, Fery-Blanco C, et al. Pedicle stress fracture: an unusual complication of pycnodysostosis. Clin Rheumatol, 2008, 27(3): 385-387.
22. Doita M, Ando Y, Hirata S, et al. Bilateral pedicle stress fracture in a patient with osteoporotic compression fracture. Eur Spine J, 2009, 18(Suppl 2): 206-209.
23. Jeong IH, Hwang EH, Bae WT. Contralateral Pedicular Fracture with Unilateral Spondylolysis. J Korean Neurosurg Soc, 2009, 46(6): 584-587.
24. Amari R, Sakai T, Katoh S, et al. Fresh stress fractures of lumbar pedicles in an adolescent male ballet dancer: Case report and literature review. Arch Orthop Trauma Surg, 2009, 129(3): 397-401.
25. Johnson JN, Wang MY. Stress fracture of the lumbar pedicle bilaterally: surgical repair using a percutaneous minimally invasive technique. J Neurosurg Spine, 2009, 11(6): 724-728.
26. Hajjioui A, Khazzani H, Sbihi S, et al. Spondylolisthesis on bilateral pedicle stress fracture in the lumbar spine: a case study. Ann Phys Rehabil Med, 2011, 54(1): 53-58.

Chinese Journal of Reparative and Reconstructive Surgery

RESEARCH PROGRESS OF STRESS FRACTURE OF LUMBAR PEDICLE

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