Bilateral lumbar pedicle fracture

Case contributed by Paul Siasat

Presentation

Found on floor. Denies a history of trauma. Complains of lower back pain.

Patient Data

Age: 80 years
Gender: Female

There are six lumbar-type vertebrae.

At L3 there are bilateral undisplaced fractures at the junction of the pedicles and body. There is some evidence that these are not immediately recent.

Marked degenerative change affects the L3/4 disc where there is narrowing, marginal lipping and slight subluxation.

There is a mild, at least partially acute, compression fracture in the superior end plate of L4. The posterior elements are not involved. Mild narrowing of the canal and left foramen results.

Marked canal stenosis affects the L4/5 disc level and there is a marked compression fracture in the L5 vertebral body which appears both partly acute and partly chronic. There is also severe apophyseal joint osteoarthritis.

At L5/6 there is subluxation and severe degenerative change resulting in severe canal stenosis. There is also a severe compression fracture in the L6 vertebral body, largely longstanding but possibly with a small acute component.

Case Discussion

Bilateral fractures of the lumbar spine are a rare clinical entity. They can develop due to abnormal stresses in the pedicle from previous spinal surgery or spondylitic changes. In this case, there was severe degenerative disease of the lumbar spine and wedge compression fractures.

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