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Sacral Insufficiency Fractures Following Multilevel Instrumented Spinal Fusion: Case Report

Khan, Mustafa H., MD; Smith, Patrick N., MD; Kang, James D., MD

doi: 10.1097/01.brs.0000174272.63548.89
Case Report

Study Design. Case series.

Objective. To report a series of patients in whom sacral insufficiency fractures developed following multilevel spinal fusion with instrumentation.

Summary of Background Data. Rigid spinal fusion with instrumentation results in abnormal distribution of forces in the spine. These forces have the potential to cause failure of adjacent segments, especially in older, osteopenic individuals. Sacral insufficiency fractures following lumbar-sacral fusion may be the result of these abnormal forces. However, this complication is not well described in the literature.

Methods. Three patients who sustained sacral fractures after instrumented lumbar-sacral fusion performed for degenerative disease of the spine are discussed. History, physical examination findings, and radiographic features are presented, along with a brief review of the pertinent literature.

Results. All 3 patients in our series started complaining of new-onset buttock pain a few weeks after their operative procedure. Radiographic examination revealed that they had transverse sacral fractures just below the fusion instrumentation. Nonoperative, conservative treatment was performed. At final follow-up, the fractures had healed completely and the patients’ complaints had resolved.

Conclusion. Patients who complain of new-onset buttock pain following multilevel lumbar-sacral fusion with instrumentation should be evaluated for sacral insufficiency fractures, especially if they have been sitting for prolonged periods. Conservative treatment seems to be sufficient.

Sacral insufficiency fracture is an unusual complication of instrumented lumbar-sacral fusions. A high index of suspicion is needed to diagnose this entity. Three such cases are presented with a brief review of the pertinent literature.

From the Department of Orthopedic Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA.

Acknowledgment date: October 25, 2004. First revision date: February 1, 2005. Acceptance date: February 3, 2005.

The manuscript submitted does not contain information about medical device(s)/drug(s).

No funds were received in support of this work. No benefits in any form have been or will be received from a commercial party related directly or indirectly to the subject of this manuscript.

Address correspondence and reprint requests to James D. Kang, MD, Suite 1010, 3741 Fifth Avenue, Pittsburgh, PA 15213; E-mail:

© 2005 Lippincott Williams & Wilkins, Inc.