Skip to main content
Erschienen in: Clinical Orthopaedics and Related Research® 2/2009

01.02.2009 | Orthopaedic • Radiology • Pathology Conference

Low Backache in a 70-year-old Woman

verfasst von: Aditya V. Maheshwari, MD, Jeremy S. Frank, MD, J. David Pitcher Jr., MD, H. Thomas Temple, MD

Erschienen in: Clinical Orthopaedics and Related Research® | Ausgabe 2/2009

Einloggen, um Zugang zu erhalten

Excerpt

A 70-year-old woman presented with a 1-year history of progressive low back pain. The onset was insidious without antecedent trauma. She was earlier seen at another institution, where a sacral lesion was found and a CT-guided needle biopsy was performed twice with inconclusive results. The pain subsequently worsened and was exacerbated by activities, especially flexion of the hip, and was relieved by rest and oral and transdermal narcotics. She had occasional nocturnal pain and paresthesias, radiating in the posterior right lower extremity. She also complained of constipation but did not have any urinary symptoms or rectal bleeding. She denied any constitutional symptoms. …
Literatur
1.
Zurück zum Zitat Abe H, Nakamura M, Takahashi S, Maruoka S, Ogawa Y, Sakamoto K. Radiation-induced insufficiency fractures of the pelvis: evaluation with 99mTc-methylene diphosphonate scintigraphy. AJR Am J Roentgenol. 1992;158:599–602.PubMed Abe H, Nakamura M, Takahashi S, Maruoka S, Ogawa Y, Sakamoto K. Radiation-induced insufficiency fractures of the pelvis: evaluation with 99mTc-methylene diphosphonate scintigraphy. AJR Am J Roentgenol. 1992;158:599–602.PubMed
2.
Zurück zum Zitat Baxter NN, Habermann EB, Tepper JE, Durham SB, Virnig BA. Risk of pelvic fractures in older women following pelvic irradiation. JAMA. 2005;294:2587–2593.PubMedCrossRef Baxter NN, Habermann EB, Tepper JE, Durham SB, Virnig BA. Risk of pelvic fractures in older women following pelvic irradiation. JAMA. 2005;294:2587–2593.PubMedCrossRef
3.
Zurück zum Zitat Bliss P, Parsons CA, Blake PR. Incidence and possible aetiological factors in the development of pelvic insufficiency fractures following radical radiotherapy. Br J Radiol. 1996;69:548–554.PubMedCrossRef Bliss P, Parsons CA, Blake PR. Incidence and possible aetiological factors in the development of pelvic insufficiency fractures following radical radiotherapy. Br J Radiol. 1996;69:548–554.PubMedCrossRef
4.
Zurück zum Zitat Blomlie V, Lien HH, Iversen T, Winderen M, Tvera K. Radiation-induced insufficiency fractures of the sacrum: evaluation with MR imaging. Radiology. 1993;188:241–244.PubMed Blomlie V, Lien HH, Iversen T, Winderen M, Tvera K. Radiation-induced insufficiency fractures of the sacrum: evaluation with MR imaging. Radiology. 1993;188:241–244.PubMed
5.
Zurück zum Zitat Blomlie V, Rofstad EK, Talle K, Sundfor K, Winderen M, Lien HH. Incidence of radiation-induced insufficiency fractures of the female pelvis: evaluation with MR imaging. AJR Am J Roentgenol. 1996;167:1205–1210.PubMed Blomlie V, Rofstad EK, Talle K, Sundfor K, Winderen M, Lien HH. Incidence of radiation-induced insufficiency fractures of the female pelvis: evaluation with MR imaging. AJR Am J Roentgenol. 1996;167:1205–1210.PubMed
6.
Zurück zum Zitat Cahan WG, Woodard HQ, Higinbotham NL, Stewart FW, Coley BL. Sarcoma arising in irradiated bone: report of eleven cases. 1948. Cancer. 1998;82:8–34.PubMedCrossRef Cahan WG, Woodard HQ, Higinbotham NL, Stewart FW, Coley BL. Sarcoma arising in irradiated bone: report of eleven cases. 1948. Cancer. 1998;82:8–34.PubMedCrossRef
7.
Zurück zum Zitat Clayer M, Duncan W. Importance of biopsy of new bone lesions in patients with previous carcinoma. Clin Orthop Relat Res. 2006;451:208–211.PubMedCrossRef Clayer M, Duncan W. Importance of biopsy of new bone lesions in patients with previous carcinoma. Clin Orthop Relat Res. 2006;451:208–211.PubMedCrossRef
8.
Zurück zum Zitat Cooper KL, Beabout JW, Swee RG. Insufficiency fractures of the sacrum. Radiology. 1985;156:15–20.PubMed Cooper KL, Beabout JW, Swee RG. Insufficiency fractures of the sacrum. Radiology. 1985;156:15–20.PubMed
9.
Zurück zum Zitat Daffner RH, Pavlov H. Stress fractures: current concepts. AJR Am J Roentgenol. 1992;159:245–252.PubMed Daffner RH, Pavlov H. Stress fractures: current concepts. AJR Am J Roentgenol. 1992;159:245–252.PubMed
10.
Zurück zum Zitat Dalinka MK, Edeiken J, Finkelstein JB. Complications of radiation therapy: adult bone. Semin Roentgenol. 1974;9:29–40.PubMedCrossRef Dalinka MK, Edeiken J, Finkelstein JB. Complications of radiation therapy: adult bone. Semin Roentgenol. 1974;9:29–40.PubMedCrossRef
11.
Zurück zum Zitat De Smet AA, Neff JR. Pubic and sacral insufficiency fractures: clinical course and radiologic findings. AJR Am J Roentgenol. 1985;145:601–606.PubMed De Smet AA, Neff JR. Pubic and sacral insufficiency fractures: clinical course and radiologic findings. AJR Am J Roentgenol. 1985;145:601–606.PubMed
12.
Zurück zum Zitat Feltl D, Vosmik M, Jirasek M, Stahalova V, Kubes J. Symptomatic osteoradionecrosis of pelvic bones in patients with gynecological malignancies: result of a long-term follow-up. Int J Gynecol Cancer. 2006;16:478–483.PubMedCrossRef Feltl D, Vosmik M, Jirasek M, Stahalova V, Kubes J. Symptomatic osteoradionecrosis of pelvic bones in patients with gynecological malignancies: result of a long-term follow-up. Int J Gynecol Cancer. 2006;16:478–483.PubMedCrossRef
13.
Zurück zum Zitat Fu AL, Greven KM, Maruyama Y. Radiation osteitis and insufficiency fractures after pelvic irradiation for gynecologic malignancies. Am J Clin Oncol. 1994;17:248–254.PubMedCrossRef Fu AL, Greven KM, Maruyama Y. Radiation osteitis and insufficiency fractures after pelvic irradiation for gynecologic malignancies. Am J Clin Oncol. 1994;17:248–254.PubMedCrossRef
14.
Zurück zum Zitat Grangier C, Garcia J, Howarth NR, May M, Rossier P. Role of MRI in the diagnosis of insufficiency fractures of the sacrum and acetabular roof. Skeletal Radiol. 1997;26:517–524.PubMedCrossRef Grangier C, Garcia J, Howarth NR, May M, Rossier P. Role of MRI in the diagnosis of insufficiency fractures of the sacrum and acetabular roof. Skeletal Radiol. 1997;26:517–524.PubMedCrossRef
15.
Zurück zum Zitat Grasland A, Pouchot J, Mathieu A, Paycha F, Vinceneux P. Sacral insufficiency fractures: an easily overlooked cause of back pain in elderly women. Arch Intern Med. 1996;156:668–674.PubMedCrossRef Grasland A, Pouchot J, Mathieu A, Paycha F, Vinceneux P. Sacral insufficiency fractures: an easily overlooked cause of back pain in elderly women. Arch Intern Med. 1996;156:668–674.PubMedCrossRef
16.
Zurück zum Zitat Howland WJ, Loeffler RK, Starchman DE, Johnson RG. Postirradiation atrophic changes of bone and related complications. Radiology. 1975;117:677–685.PubMed Howland WJ, Loeffler RK, Starchman DE, Johnson RG. Postirradiation atrophic changes of bone and related complications. Radiology. 1975;117:677–685.PubMed
17.
Zurück zum Zitat Huh SJ, Kim B, Kang MK, Lee JE, Lim DH, Park W, Shin SS, Ahn YC. Pelvic insufficiency fracture after pelvic irradiation in uterine cervix cancer. Gynecol Oncol. 2002;86:264–268.PubMedCrossRef Huh SJ, Kim B, Kang MK, Lee JE, Lim DH, Park W, Shin SS, Ahn YC. Pelvic insufficiency fracture after pelvic irradiation in uterine cervix cancer. Gynecol Oncol. 2002;86:264–268.PubMedCrossRef
18.
Zurück zum Zitat Ikushima H, Osaki K, Furutani S, Yamashita K, Kishida Y, Kudoh T, Nishitani H. Pelvic bone complications following radiation therapy of gynecologic malignancies: clinical evaluation of radiation-induced pelvic insufficiency fractures. Gynecol Oncol. 2006;103:1100–1104.PubMedCrossRef Ikushima H, Osaki K, Furutani S, Yamashita K, Kishida Y, Kudoh T, Nishitani H. Pelvic bone complications following radiation therapy of gynecologic malignancies: clinical evaluation of radiation-induced pelvic insufficiency fractures. Gynecol Oncol. 2006;103:1100–1104.PubMedCrossRef
19.
Zurück zum Zitat Konski A, Sowers M. Pelvic fractures following irradiation for endometrial carcinoma. Int J Radiat Oncol Biol Phys. 1996;35:361–367.PubMed Konski A, Sowers M. Pelvic fractures following irradiation for endometrial carcinoma. Int J Radiat Oncol Biol Phys. 1996;35:361–367.PubMed
20.
Zurück zum Zitat Leroux JL, Denat B, Thomas E, Blotman F, Bonnel F. Sacral insufficiency fractures presenting as acute low-back pain: biomechanical aspects. Spine. 1993;18:2502–2506.PubMedCrossRef Leroux JL, Denat B, Thomas E, Blotman F, Bonnel F. Sacral insufficiency fractures presenting as acute low-back pain: biomechanical aspects. Spine. 1993;18:2502–2506.PubMedCrossRef
22.
Zurück zum Zitat Lin JT, Lane JM. Sacral stress fractures. J Womens Health (Larchmt). 2003;12:879–888. Lin JT, Lane JM. Sacral stress fractures. J Womens Health (Larchmt). 2003;12:879–888.
23.
Zurück zum Zitat Lourie H. Spontaneous osteoporotic fracture of the sacrum: an unrecognized syndrome of the elderly. JAMA. 1982;248:715–717.PubMedCrossRef Lourie H. Spontaneous osteoporotic fracture of the sacrum: an unrecognized syndrome of the elderly. JAMA. 1982;248:715–717.PubMedCrossRef
24.
Zurück zum Zitat Lundin B, Bjorkholm E, Lundell M, Jacobsson H. Insufficiency fractures of the sacrum after radiotherapy for gynaecological malignancy. Acta Oncol. 1990;29:211–215.PubMedCrossRef Lundin B, Bjorkholm E, Lundell M, Jacobsson H. Insufficiency fractures of the sacrum after radiotherapy for gynaecological malignancy. Acta Oncol. 1990;29:211–215.PubMedCrossRef
25.
Zurück zum Zitat Mogard J, Kihlstrom L, Ericson K, Karlsson B, Guo WY, Stone-Elander S. Recurrent tumor vs radiation effects after gamma knife radiosurgery of intracerebral metastases: diagnosis with PET-FDG. J Comput Assist Tomogr. 1994;18:177–181.PubMedCrossRef Mogard J, Kihlstrom L, Ericson K, Karlsson B, Guo WY, Stone-Elander S. Recurrent tumor vs radiation effects after gamma knife radiosurgery of intracerebral metastases: diagnosis with PET-FDG. J Comput Assist Tomogr. 1994;18:177–181.PubMedCrossRef
26.
Zurück zum Zitat Moreno A, Clemente J, Crespo C, Martínez A, Navarro M, Fernández L, Minguell J, Vázquez G, Andreu FJ. Pelvic insufficiency fractures in patients with pelvic irradiation. Int J Radiat Oncol Biol Phys. 1999;44:61–66.PubMedCrossRef Moreno A, Clemente J, Crespo C, Martínez A, Navarro M, Fernández L, Minguell J, Vázquez G, Andreu FJ. Pelvic insufficiency fractures in patients with pelvic irradiation. Int J Radiat Oncol Biol Phys. 1999;44:61–66.PubMedCrossRef
27.
Zurück zum Zitat Mumber MP, Greven KM, Haygood TM. Pelvic insufficiency fractures associated with radiation atrophy: clinical recognition and diagnostic evaluation. Skeletal Radiol. 1997;26:94–99.PubMedCrossRef Mumber MP, Greven KM, Haygood TM. Pelvic insufficiency fractures associated with radiation atrophy: clinical recognition and diagnostic evaluation. Skeletal Radiol. 1997;26:94–99.PubMedCrossRef
28.
Zurück zum Zitat Ogino I, Okamoto N, Ono Y, Kitamura T, Nakayama H. Pelvic insufficiency fractures in postmenopausal woman with advanced cervical cancer treated by radiotherapy. Radiother Oncol. 2003;68:61–67.PubMedCrossRef Ogino I, Okamoto N, Ono Y, Kitamura T, Nakayama H. Pelvic insufficiency fractures in postmenopausal woman with advanced cervical cancer treated by radiotherapy. Radiother Oncol. 2003;68:61–67.PubMedCrossRef
29.
Zurück zum Zitat Peh WC, Khong PL, Sham JS, Ho WY, Yeung HW. Sacral and pubic insufficiency fractures after irradiation of gynaecological malignancies. Clin Oncol (R Coll Radiol). 1995;7:117–122. Peh WC, Khong PL, Sham JS, Ho WY, Yeung HW. Sacral and pubic insufficiency fractures after irradiation of gynaecological malignancies. Clin Oncol (R Coll Radiol). 1995;7:117–122.
30.
Zurück zum Zitat Ries T. Detection of osteoporotic sacral fractures with radionuclides. Radiology. 1983;146:783–785.PubMed Ries T. Detection of osteoporotic sacral fractures with radionuclides. Radiology. 1983;146:783–785.PubMed
31.
Zurück zum Zitat Schmid L, Pfirrmann C, Hess T, Schlumpf U. Bilateral fracture of the sacrum associated with pregnancy: a case report. Osteoporos Int. 1999;10:91–93.PubMedCrossRef Schmid L, Pfirrmann C, Hess T, Schlumpf U. Bilateral fracture of the sacrum associated with pregnancy: a case report. Osteoporos Int. 1999;10:91–93.PubMedCrossRef
32.
Zurück zum Zitat Schneider R, Yacovone J, Ghelman B. Unsuspected sacral fractures: detection by radionuclide bone scanning. AJR Am J Roentgenol. 1985;144:337–341.PubMed Schneider R, Yacovone J, Ghelman B. Unsuspected sacral fractures: detection by radionuclide bone scanning. AJR Am J Roentgenol. 1985;144:337–341.PubMed
33.
Zurück zum Zitat Tai P, Hammond A, Dyk JV, Stitt L, Tonita J, Coad T, Radwan J. Pelvic fractures following irradiation of endometrial and vaginal cancers: a case series and review of literature. Radiother Oncol. 2000;56:23–28.PubMedCrossRef Tai P, Hammond A, Dyk JV, Stitt L, Tonita J, Coad T, Radwan J. Pelvic fractures following irradiation of endometrial and vaginal cancers: a case series and review of literature. Radiother Oncol. 2000;56:23–28.PubMedCrossRef
34.
Zurück zum Zitat Tountas AA, Fornasier VL, Harwood AR, Leung PM. Postirradiation sarcoma of bone: a perspective. Cancer. 1979;43:182–187.PubMedCrossRef Tountas AA, Fornasier VL, Harwood AR, Leung PM. Postirradiation sarcoma of bone: a perspective. Cancer. 1979;43:182–187.PubMedCrossRef
35.
Zurück zum Zitat Weatherby RP, Dahlin DC, Ivins JC. Postradiation sarcoma of bone: review of 78 Mayo Clinic cases. Mayo Clin Proc. 1981;56:294–306.PubMed Weatherby RP, Dahlin DC, Ivins JC. Postradiation sarcoma of bone: review of 78 Mayo Clinic cases. Mayo Clin Proc. 1981;56:294–306.PubMed
36.
Zurück zum Zitat Weber M, Hasler P, Gerber H. Insufficiency fractures of the sacrum: twenty cases and review of the literature. Spine. 1993;18:2507–2512.PubMedCrossRef Weber M, Hasler P, Gerber H. Insufficiency fractures of the sacrum: twenty cases and review of the literature. Spine. 1993;18:2507–2512.PubMedCrossRef
Metadaten
Titel
Low Backache in a 70-year-old Woman
verfasst von
Aditya V. Maheshwari, MD
Jeremy S. Frank, MD
J. David Pitcher Jr., MD
H. Thomas Temple, MD
Publikationsdatum
01.02.2009
Verlag
Springer-Verlag
Erschienen in
Clinical Orthopaedics and Related Research® / Ausgabe 2/2009
Print ISSN: 0009-921X
Elektronische ISSN: 1528-1132
DOI
https://doi.org/10.1007/s11999-008-0166-y

Weitere Artikel der Ausgabe 2/2009

Clinical Orthopaedics and Related Research® 2/2009 Zur Ausgabe

Symposium: Clinical Risk and Judicial Reasoning

Juries and Medical Malpractice Claims: Empirical Facts versus Myths

Arthropedia

Grundlagenwissen der Arthroskopie und Gelenkchirurgie. Erweitert durch Fallbeispiele, Videos und Abbildungen. 
» Jetzt entdecken

Proximale Humerusfraktur: Auch 100-Jährige operieren?

01.05.2024 DCK 2024 Kongressbericht

Mit dem demographischen Wandel versorgt auch die Chirurgie immer mehr betagte Menschen. Von Entwicklungen wie Fast-Track können auch ältere Menschen profitieren und bei proximaler Humerusfraktur können selbst manche 100-Jährige noch sicher operiert werden.

Sind Frauen die fähigeren Ärzte?

30.04.2024 Gendermedizin Nachrichten

Patienten, die von Ärztinnen behandelt werden, dürfen offenbar auf bessere Therapieergebnisse hoffen als Patienten von Ärzten. Besonders gilt das offenbar für weibliche Kranke, wie eine Studie zeigt.

Notfall-TEP der Hüfte ist auch bei 90-Jährigen machbar

26.04.2024 Hüft-TEP Nachrichten

Ob bei einer Notfalloperation nach Schenkelhalsfraktur eine Hemiarthroplastik oder eine totale Endoprothese (TEP) eingebaut wird, sollte nicht allein vom Alter der Patientinnen und Patienten abhängen. Auch über 90-Jährige können von der TEP profitieren.

Arthroskopie kann Knieprothese nicht hinauszögern

25.04.2024 Gonarthrose Nachrichten

Ein arthroskopischer Eingriff bei Kniearthrose macht im Hinblick darauf, ob und wann ein Gelenkersatz fällig wird, offenbar keinen Unterschied.

Update Orthopädie und Unfallchirurgie

Bestellen Sie unseren Fach-Newsletter und bleiben Sie gut informiert.