Low back pain during pregnancy caused by a sacral stress fracture: A case report

Department of Orthopedic and Trauma Surgery, University of Aachen Medical Center, 30 Pauwels Street, 52074 Aachen, Germany. .
Journal of Medical Case Reports 04/2012; 6(1):98. DOI: 10.1186/1752-1947-6-98
Source: PubMed


Sacral stress fractures are a rare but well known cause of low back pain. This type of fracture has also been observed as a postpartum complication. To date, no cases of intrapartum sacral stress fractures have been described in the literature.
We report the case of a 26-year-old Caucasian European primigravid patient (30 weeks and two days of gestation) who presented to our outpatient clinic with severe low back pain that had started after a downhill walk 14 days previously. She had no history of trauma. A magnetic resonance imaging scan revealed a non-displaced stress fracture of the right lateral mass of her sacrum. Following her decision to opt for non-operative treatment, our patient received an epidural catheter for pain control. The remaining course of her pregnancy was uneventful and our patient gave birth to a healthy child by normal vaginal delivery.
We conclude that a sacral stress fracture must be considered as a possible cause of low back pain during pregnancy.

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    • "Because of its subtle clinical and radiologic features, diagnosis is often missed. Patients usually present with low-back, buttock, or pelvic pain-with or without radiating pain to the lower extremity [1,2]. When radicular symptoms do accompany the pain however, it may distract clinicians from the proper diagnosis of sacral fracture. "
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    ABSTRACT: Background: Sacral stress fracture during pregnancy is an uncommon condition with unclear pathophysiology, presenting with non-specific symptoms and clinical findings. To date, few cases have been published in the literature describing the occurrence of sacral stress fracture during pregnancy. Case report: We report a 28-year-old primigravid patient who developed lumbosacral pain at the end of the second trimester. Symptoms were overlooked throughout pregnancy and the postpartum period, resulting in the development of secondary chronic gait and balance problems. Conclusions: Stress fracture of the sacrum should be included in the differential diagnosis of low back and sacral pain during pregnancy. Its prevalence is probably underestimated because of the lack of specificity of the symptoms. Plain radiographs are not appropriate due to radiation exclusion; magnetic resonance is the only method that can be applied safely. There is limited information on natural history but many patients are expected to have a benign course. However, misdiagnosis may lead to prolonged morbidity and the development of secondary gait abnormalities. Stress fracture of the sacrum should be included in the differential diagnosis of low back and sacral pain during pregnancy. A high index of suspicion is necessary to establish an early diagnosis and appropriate treatment.
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