# L5 Pedicle Fracture Following Single-Level L4-5 Posterior Lumbar Interbody Fusion: Successful Outcomes With Conservative Treatment in Two Cases

## TL;DR

Two elderly patients with L5 pedicle fractures after spinal surgery healed without surgery using rest and a bone drug.

## Contribution

First report of successful conservative treatment for L5 pedicle fractures after PLIF without revision surgery.

## Key findings

- Two patients with L5 pedicle fractures after L4-5 PLIF healed with conservative treatment.
- Conservative treatment included bed rest and teriparatide therapy leading to bone union.
- Early detection and monitoring improved outcomes in patients with poor spinal alignment.

## Abstract

This report describes two cases of bilateral L5 pedicle fractures following L4-5 posterior lumbar interbody fusion (PLIF) for L4 degenerative spondylolisthesis in female patients (68 and 72 years old). While this rare complication typically requires revision surgery with the extension of fixation to the sacrum or ilium, both patients achieved successful healing through conservative treatment consisting of bed rest (4-6 weeks) combined with daily teriparatide therapy (20 µg). The fractures occurred early postoperatively (5 and 36 days) and were detected through CT imaging. Both patients presented with high preoperative L4 sagittal vertical axis values (68 mm and 64 mm). At the final follow-up (36 and 18 months, respectively), both patients were free from neurological deficits with confirmed bone union. These cases represent the first report of successful conservative management of this complication. Early detection through careful monitoring in the postoperative period, particularly in cases with poor sagittal alignment of the lower lumbar spine, may lead to successful conservative treatment and help avoid revision surgery.