Lumbar Pedicular Stress Fracture Post-laminectomy: a Case Report

We present the case of a 74-year-old male suffering from degenerative lumbar spinal stenosis with neurogenic claudication resulting in reduced walking distance. MR imaging indicated spinal canal stenosis at the level of L3-L4 and L4-L5 due to degenerative discopathy, discal extrusion, and facet arthrosis. After conservative treatment had failed, a multilevel laminectomy was performed. Four months postoperatively, the patient developed a stress fracture of the L4 pedicle. Pedicular stress fractures are uncommon and few case reports are found in the literature. Usually, they occur due to contralateral spondylolysis or congenital anomalies. The findings in this case however suggest a change of biomechanical load over the pedicle due to spinal surgery. An overview of the literature concerning spinal instability after laminectomy is provided. Spinal decompressive surgery can significantly change the biomechanical forces on the spinal structures, resulting in important postoperative complications. Whether pedicle stress fracture in this case is a result of pre- or postoperative circumstances remains a subject for discussion.