Fourney Daryl R, Prabhu Sujit S, Cohen Zvi R, Gokaslan Ziya L, Rhines Laurence D
Department of Neurosurgery, University of Saskatchewan, Royal University Hospital, Saskatoon, Saskatchewan, Canada.
Neurosurgery. 2002 Dec;51(6):1507-10; discussion 1510-1.
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.
早期骶骨骨折是老年骨质疏松女性行腰骶部器械融合术极为罕见的并发症。既往报道将该问题归因于多节段（三个或更多节段）固定的使用，即应力从刚性脊柱植入物转移至骶骨。据我们所知，我们报告了唯一一例二级腰骶部融合术后早期骶骨骨折的病例，以及唯一一例腰椎滑脱复位术后早期骶骨骨折的病例。
一名患者在腰骶部减压、L5 - S1 Ⅱ度腰椎滑脱复位及包括后路腰椎椎间融合术在内的 L5 - S1 器械融合术后数天，突然出现腰背部及臀部疼痛复发。4 周后 X 线平片发现骶骨横行骨折。
通过支具治疗及骨质疏松药物治疗，症状得到改善。
早期骶骨骨折是腰骶部器械融合术后疼痛的罕见原因。尽管对于多节段融合而言，载荷从刚性脊柱植入物转移至相邻节段的问题尤为突出，但短节段固定的患者也可能受到影响。腰椎滑脱的积极复位可能会增加相邻节段应力，从而导致这一并发症。
