A case of symptomatic bilateral fracture of the superior articular process of the sacrum in a 21-year-old speed skater.

The patient was admitted for close observation after complaining of excruciating low back pain and bilateral dysesthesia along the L5 nerve root.

CT myelogram 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 interbody fusion (PLIF) at L5/S1. The patient showed immediate improvement and returned to training six months post-operatively.

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 ¹⁾.