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Pedicle Stress Fracture
Bryson Borg, MD; Jeffrey S. Ross, MD
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KEY FACTS

  • Terminology

    • Imaging

      • Top Differential Diagnoses

        • Pathology

          • Diagnostic Checklist

            TERMINOLOGY

            • Synonyms

              • Pediculolysis
            • Definitions

              • Insufficiency fracture: Fracture due to physiological stress on abnormally weak bone
              • Fatigue fracture: Fracture due to increased stress on normal bone

            IMAGING

            • General Features

              • Radiographic Findings

                • CT Findings

                  • MR Findings

                    • Nuclear Medicine Findings

                      • Imaging Recommendations

                        DIFFERENTIAL DIAGNOSIS

                          PATHOLOGY

                          • General Features

                            CLINICAL ISSUES

                            • Presentation

                              • Demographics

                                • Natural History & Prognosis

                                  • Treatment

                                    DIAGNOSTIC CHECKLIST

                                    • Consider

                                      • Image Interpretation Pearls

                                        Selected References

                                        1. Estrada, Jorge Alberto De Haro et al. Bilateral fracture of L5 pedicles in a patient with total disc replacement of L5-S1: a case report. Coluna/Columna [online]. 2014, vol.13, n.2 [cited 2015-01-02], pp. 153-155. http://dx.doi.org/10.1590/S1808-18512014130200456.
                                        2. Borg B et al: Pedicle marrow signal hyperintensity on short tau inversion recovery- and t2-weighted images: prevalence and relationship to clinical symptoms. AJNR Am J Neuroradiol. 32(9):1624-31, 2011
                                        3. El Rachkidi R et al: Atypical bilateral pedicle fracture in long-term bisphosphonate therapy. Spine (Phila Pa 1976). 36(26):E1769-73, 2011
                                        4. Amari R et al: Fresh stress fractures of lumbar pedicles in an adolescent male ballet dancer: case report and literature review. Arch Orthop Trauma Surg. 129(3):397-401, 2009
                                        5. Doita M et al: Bilateral pedicle stress fracture in a patient with lumbar spinal stenosis: a case report. J Spinal Disord Tech. 21(7):531-4, 2008
                                        6. Vialle R et al: Acute L5 pedicle fracture and contralateral spondylolysis in a 12-year-old boy: a case report. Eur Spine J. 16 Suppl 3:316-7, 2007
                                        7. Sadiq MZ: Bilateral pedicle stress fracture in the lumbar spine of a sedentary office worker. Eur Spine J. 15 Suppl 5:653-5, 2006
                                        8. Sairyo K et al: Athletes with unilateral spondylolysis are at risk of stress fracture at the contralateral pedicle and pars interarticularis: a clinical and biomechanical study. Am J Sports Med. 33(4):583-90, 2005
                                        9. Parvataneni HK et al: Bilateral pedicle stress fractures in a female athlete: case report and review of the literature. Spine (Phila Pa 1976). 29(2):E19-21, 2004
                                        10. Bose B: Fracture of S1-2 after L4-S1 decompression and fusion. Case report and review of the literature. J Neurosurg. 99(3 Suppl):310-2, 2003
                                        11. Ha KY et al: Bilateral pedicle stress fracture after instrumented posterolateral lumbar fusion: a case report. Spine (Phila Pa 1976). 28(8):E158-60, 2003
                                        12. Hollenberg GM et al: Imaging of the spine in sports medicine. Curr Sports Med Rep. 2(1):33-40, 2003
                                        13. Slipman CW et al: Sacral stress fracture in a female field hockey player. Am J Phys Med Rehabil. 82(11):893-6, 2003
                                        14. Fourney DR et al: Early sacral stress fracture after reduction of spondylolisthesis and lumbosacral fixation: case report. Neurosurgery. 51(6):1507-10; discussion 1510-1, 2002
                                        15. Kraft DE: Low back pain in the adolescent athlete. Pediatr Clin North Am. 49(3):643-53, 2002
                                        16. Reitman CA et al: Lumbar isthmic defects in teenagers resulting from stress fractures. Spine J. 2(4):303-6, 2002
                                        17. Shah MK et al: Sacral stress fractures: an unusual cause of low back pain in an athlete. Spine. 27(4):E104-8, 2002
                                        18. Sheehan JP et al: Stress fracture of the pedicle after extensive decompression and contralateral posterior fusion for lumbar stenosis. Report of three cases. Neurosurg Focus. 13(2):E9, 2002
                                        19. Sirvanci M et al: Pedicular stress fracture in lumbar spine. Clin Imaging. 26(3): 187-93, 2002
                                        20. Macdessi SJ et al: Pedicle fracture after instrumented posterolateral lumbar fusion: a case report. Spine (Phila Pa 1976). 26(5):580-2, 2001
                                        21. Guillodo Y et al: Contralateral spondylolysis and fracture of the lumbar pedicle in an elite female gymnast: a case report. Spine (Phila Pa 1976). 25(19):2541-3, 2000
                                        22. Chong VF et al: Pedicular stress fracture in the lumbar spine. Australas Radiol. 41(3): 306-7, 1997
                                        23. Heggeness MH et al: The trabecular anatomy of thoracolumbar vertebrae: implications for burst fractures. J Anat. 191 ( Pt 2): 309-12, 1997
                                        24. Robertson PA et al: Stress fracture of the pedicle. A late complication of posterolateral lumbar fusion. Spine (Phila Pa 1976). 18(7):930-2, 1993
                                        25. Gunzburg R et al: Stress fracture of the lumbar pedicle. Case reports of "pediculolysis" and review of the literature. Spine (Phila Pa 1976). 16(2):185-9, 1991
                                        26. Traughber PD et al: Bilateral pedicle stress fractures: SPECT and CT features. J Comput Assist Tomogr. 15(2): 338-40, 1991
                                        27. Stanley D et al: Contralateral pedicle stress fracture. An unusual complication of laminectomy. Spine (Phila Pa 1976). 15(6):598-9, 1990
                                        28. Garber JE et al: Unilateral spondylolysis and contralateral pedicle fracture. Spine (Phila Pa 1976). 11(1):63-6, 1986
                                        Related Anatomy
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                                        Related Differential Diagnoses
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                                        References
                                        Tables

                                        Tables

                                        KEY FACTS

                                        • Terminology

                                          • Imaging

                                            • Top Differential Diagnoses

                                              • Pathology

                                                • Diagnostic Checklist

                                                  TERMINOLOGY

                                                  • Synonyms

                                                    • Pediculolysis
                                                  • Definitions

                                                    • Insufficiency fracture: Fracture due to physiological stress on abnormally weak bone
                                                    • Fatigue fracture: Fracture due to increased stress on normal bone

                                                  IMAGING

                                                  • General Features

                                                    • Radiographic Findings

                                                      • CT Findings

                                                        • MR Findings

                                                          • Nuclear Medicine Findings

                                                            • Imaging Recommendations

                                                              DIFFERENTIAL DIAGNOSIS

                                                                PATHOLOGY

                                                                • General Features

                                                                  CLINICAL ISSUES

                                                                  • Presentation

                                                                    • Demographics

                                                                      • Natural History & Prognosis

                                                                        • Treatment

                                                                          DIAGNOSTIC CHECKLIST

                                                                          • Consider

                                                                            • Image Interpretation Pearls

                                                                              Selected References

                                                                              1. Estrada, Jorge Alberto De Haro et al. Bilateral fracture of L5 pedicles in a patient with total disc replacement of L5-S1: a case report. Coluna/Columna [online]. 2014, vol.13, n.2 [cited 2015-01-02], pp. 153-155. http://dx.doi.org/10.1590/S1808-18512014130200456.
                                                                              2. Borg B et al: Pedicle marrow signal hyperintensity on short tau inversion recovery- and t2-weighted images: prevalence and relationship to clinical symptoms. AJNR Am J Neuroradiol. 32(9):1624-31, 2011
                                                                              3. El Rachkidi R et al: Atypical bilateral pedicle fracture in long-term bisphosphonate therapy. Spine (Phila Pa 1976). 36(26):E1769-73, 2011
                                                                              4. Amari R et al: Fresh stress fractures of lumbar pedicles in an adolescent male ballet dancer: case report and literature review. Arch Orthop Trauma Surg. 129(3):397-401, 2009
                                                                              5. Doita M et al: Bilateral pedicle stress fracture in a patient with lumbar spinal stenosis: a case report. J Spinal Disord Tech. 21(7):531-4, 2008
                                                                              6. Vialle R et al: Acute L5 pedicle fracture and contralateral spondylolysis in a 12-year-old boy: a case report. Eur Spine J. 16 Suppl 3:316-7, 2007
                                                                              7. Sadiq MZ: Bilateral pedicle stress fracture in the lumbar spine of a sedentary office worker. Eur Spine J. 15 Suppl 5:653-5, 2006
                                                                              8. Sairyo K et al: Athletes with unilateral spondylolysis are at risk of stress fracture at the contralateral pedicle and pars interarticularis: a clinical and biomechanical study. Am J Sports Med. 33(4):583-90, 2005
                                                                              9. Parvataneni HK et al: Bilateral pedicle stress fractures in a female athlete: case report and review of the literature. Spine (Phila Pa 1976). 29(2):E19-21, 2004
                                                                              10. Bose B: Fracture of S1-2 after L4-S1 decompression and fusion. Case report and review of the literature. J Neurosurg. 99(3 Suppl):310-2, 2003
                                                                              11. Ha KY et al: Bilateral pedicle stress fracture after instrumented posterolateral lumbar fusion: a case report. Spine (Phila Pa 1976). 28(8):E158-60, 2003
                                                                              12. Hollenberg GM et al: Imaging of the spine in sports medicine. Curr Sports Med Rep. 2(1):33-40, 2003
                                                                              13. Slipman CW et al: Sacral stress fracture in a female field hockey player. Am J Phys Med Rehabil. 82(11):893-6, 2003
                                                                              14. Fourney DR et al: Early sacral stress fracture after reduction of spondylolisthesis and lumbosacral fixation: case report. Neurosurgery. 51(6):1507-10; discussion 1510-1, 2002
                                                                              15. Kraft DE: Low back pain in the adolescent athlete. Pediatr Clin North Am. 49(3):643-53, 2002
                                                                              16. Reitman CA et al: Lumbar isthmic defects in teenagers resulting from stress fractures. Spine J. 2(4):303-6, 2002
                                                                              17. Shah MK et al: Sacral stress fractures: an unusual cause of low back pain in an athlete. Spine. 27(4):E104-8, 2002
                                                                              18. Sheehan JP et al: Stress fracture of the pedicle after extensive decompression and contralateral posterior fusion for lumbar stenosis. Report of three cases. Neurosurg Focus. 13(2):E9, 2002
                                                                              19. Sirvanci M et al: Pedicular stress fracture in lumbar spine. Clin Imaging. 26(3): 187-93, 2002
                                                                              20. Macdessi SJ et al: Pedicle fracture after instrumented posterolateral lumbar fusion: a case report. Spine (Phila Pa 1976). 26(5):580-2, 2001
                                                                              21. Guillodo Y et al: Contralateral spondylolysis and fracture of the lumbar pedicle in an elite female gymnast: a case report. Spine (Phila Pa 1976). 25(19):2541-3, 2000
                                                                              22. Chong VF et al: Pedicular stress fracture in the lumbar spine. Australas Radiol. 41(3): 306-7, 1997
                                                                              23. Heggeness MH et al: The trabecular anatomy of thoracolumbar vertebrae: implications for burst fractures. J Anat. 191 ( Pt 2): 309-12, 1997
                                                                              24. Robertson PA et al: Stress fracture of the pedicle. A late complication of posterolateral lumbar fusion. Spine (Phila Pa 1976). 18(7):930-2, 1993
                                                                              25. Gunzburg R et al: Stress fracture of the lumbar pedicle. Case reports of "pediculolysis" and review of the literature. Spine (Phila Pa 1976). 16(2):185-9, 1991
                                                                              26. Traughber PD et al: Bilateral pedicle stress fractures: SPECT and CT features. J Comput Assist Tomogr. 15(2): 338-40, 1991
                                                                              27. Stanley D et al: Contralateral pedicle stress fracture. An unusual complication of laminectomy. Spine (Phila Pa 1976). 15(6):598-9, 1990
                                                                              28. Garber JE et al: Unilateral spondylolysis and contralateral pedicle fracture. Spine (Phila Pa 1976). 11(1):63-6, 1986