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KMID : 0388720210280040147
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Journal of Korean Society of Spine Surgery
2021 Volume.28 No. 4 p.147 ~ p.151
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Pedicle Insufficiency Fracture Following Decompressive Laminectomy in Patients Receiving Hemodialysis: A Report of Two Cases
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Choi Sung-Woo
Lee Jae-Chul
Kang Tae-Wook
Shin Byung-Joon
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Abstract
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Study Design: Case report.
Objectives: To report our experiences of patients receiving hemodialysis who had pedicle stress fractures after decompressive laminectomy.
Summary of Literature Review: The junction between the pedicle and vertebra body is a weak point in biomechanical testing. When partial laminectomy is performed in an abnormal bone condition, stress may be more concentrated around the pedicle. There are rare reports of pedicle stress fractures after spinal surgery.
Materials and Methods: Two elderly patients were admitted to our hospital due to newly developed pain after they underwent partial decompressive laminectomy. They presented with severe back pain during motion that was relieved by rest. There was no trauma history or event they remembered that could evoke such severe pain. In addition, there were no notable events during the previous surgery. Plain radiographs and computed tomography (CT) revealed pedicle insufficiency fractures at the previous decompressive laminectomy segment.
Results: Both patients revealed bony union at the previous fracture site on follow-up CT. Their pain improved and their clinical results were favorable.
Conclusions: Bone quality may be poor in patients with a long history of dialysis, and decompressive laminectomy should be performed carefully. If notable pain during motion newly develops after successful spinal surgery in these patients, pedicle stress fracture should be suspected as a possible cause.
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KEYWORD
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Insufficiency pedicle fracture, Hemodialysis, End-stage renal disease, Spine
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