Postoperative Pedicle Fracture in an Adult With Idiopathic Scoliosis After Posterior Spinal Fusion: A Case Report

TL;DR

A 22-year-old woman with a history of scoliosis developed a rare L5 pedicle fracture after spinal fusion surgery, requiring surgical removal and eventual recovery.

Contribution

Highlights a rare complication of distal pedicle stress fracture after long-segment spinal fusion and the effectiveness of surgical management.

Findings

A right L5 pedicle fracture occurred five years after posterior spinal fusion without trauma or implant failure.

Conservative treatments failed, but surgical removal of instrumentation and orthosis use led to full recovery.

The case underscores the importance of monitoring junctional stress in long-term spinal fusion follow-up.

Abstract

This case report presents the case of a 22-year-old female patient with a history of adolescent idiopathic scoliosis who underwent posterior spinal fusion and instrumentation from T4 to L5 at age 17. Her postoperative course was uneventful for five years, during which she remained asymptomatic and functionally independent. At age 22, she developed insidious axial low back pain without trauma or neurological symptoms. Imaging revealed a right L5 pedicle fracture with no evidence of implant loosening or pseudoarthrosis. Conservative management, including nonsteroidal anti-inflammatory drugs (NSAIDs), local injections, and physical therapy, failed to relieve symptoms. A CT scan confirmed solid fusion and an isolated pedicle fracture. Surgical removal of the instrumentation was performed, followed by application of a thoracolumbar orthosis. The patient returned to full daily activities without pain by one year postoperatively. This case highlights a rare complication of distal pedicle stress fracture after long-segment fusion, emphasizing the need for awareness of junctional stress-related pathology in long-term follow-up and the effectiveness of timely surgical management.

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