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Vertebral body fracture is the most common complication of osteoporosis. A thorough evaluation is needed to determine the patient's predisposition to fracture. Underlying disease states also should be addressed. Plain radiography is the standard imaging modality for spinal fractures; MRI also provides important information. Conservative treatment measures (eg, relative rest, narcotic analgesics, spinal orthoses, and extension-biased activities) are often used for pain relief, minimizing the sequelae of deconditioning, and maximizing function. Two minimally invasive percutaneous procedures, vertebroplasty and kyphoplasty, are available. Early vertebroplasty has been effective in pain relief and in precluding the adverse effects of deconditioning. Kyphoplasty has a presumed advantage of better restoration of vertebral body height and less risk of cement extravasation. [ABSTRACT FROM AUTHOR]

A 40-yr-old woman received a series of three interlaminar epidural steroid injections for the treatment of axial neck pain secondary to degenerative disc disease. Immediately after her third injection, she experienced symptoms of a dural puncture-induced headache. This headache persisted on a daily basis for 3 mos, despite two epidural blood patches using an interlaminar approach, which was finally completely abated with a transforaminal blood patch. The headache was immediately relieved and remained alleviated through the follow-up interval of 1 yr. In this patient, a fluoroscopically guided transforaminal epidural blood patch proved to be more effective than the classic blind interlaminar approach in the treatment of post-dural puncture headache. [ABSTRACT FROM AUTHOR]

Objective. To determine the inciting events leading to the development of sacroiliac joint syndrome (SIJS).Methods. This was a retrospective descriptive cohort series from an academic interdisciplinary spine center. Consecutive patients presenting with low back or buttock pain with or without leg symptoms who met specific inclusion and exclusion criteria for the diagnosis of SIJS were included in the study. Inciting events leading to the development of SIJS in these patients were categorized into traumatic, cumulative, and idiopathic events.Results. Of 194 patients who were included in the study, 54 patients had symptom resolution with one or more therapeutic intraarticular sacroiliac joint injections, following a positive diagnostic injection. Those patients were given the diagnosis of SIJS. Of these, 24 (44%) had had a traumatic event (13 motor vehicle accidents, six falls onto the buttock, three immediately postpartum, one severe football tackle, and one pelvis fracture). Eleven (21%) patients were considered to have a cumulative injury (four lifting, two running, three altered gait due to lower extremity disorder, one crew training injury, and one forceful hip extension injury). Nineteen (35%) patients had spontaneous or idiopathic onset of sacroiliac joint pain.Conclusion. SIJS can occur following a traumatic event or cumulative shear events, or can occur spontaneously. [ABSTRACT FROM AUTHOR]

We report a collegiate field hockey player who sustained a sacral fatigue-type stress fracture that manifested as persistent low back and leg pain. The diagnosis of sacral stress fracture was suggested by history and physical examination and confirmed by magnetic resonance imaging. Our patient experienced complete resolution of symptoms after a 3-mo interval of activity restriction. This article describes the first reported case of a sacral stress fracture in a field hockey player. [ABSTRACT FROM AUTHOR]