Ann Rehabil Med.  2013 Aug;37(4):582-585. 10.5535/arm.2013.37.4.582.

Postpartum Sacral Stress Fracture Mimicking Lumbar Radiculopathy in a Patient With Pregnancy-Associated Osteoporosis

• Park J
• Ok E
• Park HJ
• Hong SH
• Lee JI

• KMID: 2266617
• DOI: http://doi.org/10.5535/arm.2013.37.4.582

Abstract

Postpartum sacral fracture is relatively rare, and its diagnosis is often delayed. We herein report such a case of a 28-year-old patient who presented with an insidious-onset lower back pain, left buttock pain, and radicular symptoms mimicking lumbar radiculopathy. Laboratory tests showed a decreased 25-hydroxy vitamin D level, and the bone mineral densitometry of both femurs was below the expected range. Plain radiographs of the lumbar spine and pelvis showed no definite abnormality, but lumbosacral spinal magnetic resonance imaging identified a left sacral fracture. Symptoms were alleviated with rest and oral analgesic treatment.

Keyword

Fracture; Postpartum

MeSH Terms

Buttocks
Densitometry
Femur
Fractures, Stress
Humans
Low Back Pain
Magnetic Resonance Imaging
Osteoporosis
Pelvis
Postpartum Period
Radiculopathy
Spine
Vitamin D
Vitamin D

Figure

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  Fig. 1 Plain pelvis X-ray showing no definite abnormality.

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  Fig. 2 T2-weighted magnetic resonance image of lumbar spine showing increased signal uptake in the left sacrum.

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  Fig. 3 Bone scintigraphy showing increased uptake in left sacrum. (A) Anterior view, (B) posterior view.

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  Fig. 4 Pelvis computed tomography showing ill-defined sclerosis or mottled density in the left sacral ala.

Reference

1. Karatas M, Basaran C, Ozgul E, Tarhan C, Agildere AM. Postpartum sacral stress fracture: an unusual case of low-back and buttock pain. Am J Phys Med Rehabil. 2008; 87:418–422. PMID: 18303473.

2. Pishnamaz M, Sellei R, Pfeifer R, Lichte P, Pape HC, Kobbe P. Low back pain during pregnancy caused by a sacral stress fracture: a case report. J Med Case Rep. 2012; 6:98. PMID: 22475388.

3. Breuil V, Brocq O, Euller-Ziegler L, Grimaud A. Insufficiency fracture of the sacrum revealing a pregnancy associated osteoporosis: first case report. Ann Rheum Dis. 1997; 56:278–279. PMID: 9166005.

4. Pennick VE, Young G. Interventions for preventing and treating pelvic and back pain in pregnancy. Cochrane Database Syst Rev. 2007; (2):CD001139. PMID: 17443503.

5. Longhino V, Bonora C, Sansone V. The management of sacral stress fractures: current concepts. Clin Cases Miner Bone Metab. 2011; 8:19–23. PMID: 22461824.

6. Tsiridis E, Upadhyay N, Giannoudis PV. Sacral insufficiency fractures: current concepts of management. Osteoporos Int. 2006; 17:1716–1725. PMID: 16855863.

7. Lin JT, Lutz GE. Postpartum sacral fracture presenting as lumbar radiculopathy: a case report. Arch Phys Med Rehabil. 2004; 85:1358–1361. PMID: 15295766.

8. Finiels PJ, Finiels H, Strubel D, Jacquot JM. Spontaneous osteoporotic fractures of the sacrum causing neurological damage: report of three cases. J Neurosurg. 2002; 97(3 Suppl):380–385. PMID: 12408398.

9. Giannoudis PV, MacDonald DA, Matthews SJ, Smith RM, Furlong AJ, De Boer P. Nonunion of the femoral diaphysis: the influence of reaming and non-steroidal anti-inflammatory drugs. J Bone Joint Surg Br. 2000; 82:655–658. PMID: 10963160.

10. Kovacs CS. Calcium and bone metabolism disorders during pregnancy and lactation. Endocrinol Metab Clin North Am. 2011; 40:795–826. PMID: 22108281.