A novel technique to repair a transverse sacral fracture in a previously fused lumbosacral spondylolisthesis.

Background: Transverse fractures of the sacrum are rare, and surgical treatment for these fractures ranges from conservative to challenging. Transverse stress fractures of the sacrum after placement of lumbartosacral instrumentation have been previously described. We report a new technique to repair a transverse Type2 RoyCamille fracture with spondylolisthesis of S1 over S2 in a previously fused instrumented highgrade L4L5, L5S1 spondylolisthesis. Case Description: A 64yearold female who previously had an L4L5, L5S1 fusion for spondylolisthesis presented with excruciating lower back pain and radiculopathy for over 6 months. She was found to have an S1S2 transverse fracture caused by previous implantation of pedicle screws. She underwent repositioning of several failed right lumbar and sacral screws and then had bilateral S1S2 screws placed directly across the fracture line. The patient had an unremarkable postoperative course. She discontinued most of her pain medications within 6 weeks postoperatively. In the months following surgery, she reported only minimal lower back pain and no radiculopathy with the last appointment 5 years postoperatively. Conclusions: We describe a novel technique to reduce an iatrogenic transverse type2 RoyCamille fracture at S1S2 in a previously instrumented highgrade L4L5, L5S1 spondylolisthesis. The patient's fracture achieved adequate reduction and fusion with symptomatic relief. [ABSTRACT FROM AUTHOR]