Bilateral fracture of the superior articular process of S1 - An unusual fracture seen in a speed skater.

Background Fractures of the superior articular process are rarely seen in clinical practice. Repetitive spinal movements may lead to fractures of the pars interarticularis, resulting in spondylolysis. Traumatic spinal fractures often involve the vertebral body, transvers and/or the spinous processes. The superior articular processes, however, are seldom involved in both traumatic and stress-induced fractures. Purpose The purpose of this report is to present an unusual case of symptomatic bilateral fracture of the superior articular process of the sacrum in a 21-year-old speed skater. Study design This is a case report. Methods The patient was admitted for close observation after complaining of excruciating lower back pain and bilateral dysesthesia along the L5 nerve root. Post-myelography computed tomography (CT) revealed a bilateral facet joint deformity at L5/S1 and a bilateral fracture of the superior articular process of the sacrum. A facet joint block at the L5/S1 joint alleviated the pain, and a nerve root block at the L5 nerve root improved the dysesthesia. The patient underwent an L5/S1 decompression, whereby the nonunion bone fragments were removed, followed by a posterior lumbar inter-body fusion (PLIF) at L5/S1. Results The patient showed immediate improvement and returned to training six months post-operatively. Conclusion We have presented a case of bilateral fractures of the superior articular process of the sacrum in a speed skater. His presenting symptoms were similar to those found in patients with spondylolysis and the etiology appears to be similar. Surgical treatment was opted given his symptomatic relief from nerve root and facet joint blocks.