Traction screws to reduce a bilateral pedicle fracture of L5: a case report

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  • Department of Neurosurgery, Medical University of Innsbruck, Tyrol, Austria
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Pedicle fractures are rare and usually associated with repetitive stress, high-speed trauma, osteoporosis, unilateral spondylolysis, or instrumentation surgery. A review of the current literature on bilateral pedicle fractures of the lumbar spine revealed only a few cases listed as a complication of instrumentation or excessive decompression surgery. The authors present the clinical case of a 49-year-old man with exacerbating low-back pain and intermittent L5 radicular pain. The known comorbidities were rather remarkable for systemic lupus erythematosus and osteopenia. Radiological investigations revealed an acute bilateral pedicle fracture of L5 without any evidence of preexisting spondylolysis. An off-label minimally invasive fracture reduction and fixation was performed using traction screws and intraoperative navigation. The patient reported instant pain relief and did not show any sensorimotor deficits at discharge. The postoperative CT scan revealed an ossification of the former fracture after 3 months, with great 1-year follow-up outcome. This is the first documented report on the effectiveness of traction screws used in a patient with bilateral pedicle fractures of the L5 vertebra. This minimally invasive technique represents a promising treatment option in selected cases by sparing segmental fusion.

ABBREVIATIONS TLIF = transforaminal lumbar interbody fusion.

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Contributor Notes

Correspondence Nikolaus Kögl: Medical University of Innsbruck, Tyrol, Austria. nikolaus.koegl@tirol-kliniken.at.

INCLUDE WHEN CITING Published online March 27, 2020; DOI: 10.3171/2020.1.SPINE191229.

Disclosures Dr. Thomé reports the following: consultant for DePuy Synthes, Signus Medical, and Intrinsic Therapeutics; honoraria from Aesculap, DePuy Synthes, Medtronic, Intrinsic Therapeutics, Icotec, NuVasive, Signus Medical, and Zeiss; and non–study-related research support from DePuy Synthes, Medtronic, Intrinsic Therapeutics, Pfizer, Icotec, and Signus Medical.

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