Mitchell, Scott A.

Study Design: Retrospective case series. Objective: Sacral insufficiency fracture is a rare and serious complication following lumbar spine instrumented fusion. The purpose of this study was to describe the patient characteristics, presentation, evaluation, treatment options, and outcomes for patients with sacral insufficiency fracture after short-segment lumbosacral fusion. Methods: Six patients from our institutional database and 16 patients from literature review were identified with a sacral insufficiency fracture after short-segment (L4-S1 or L5-S1) lumbar fusion within 1 year of surgery. Results: Patients were 55% female with a mean age of 58 years and body mass index of 30 kg/m 2 . Osteoporosis or osteopenia was the most common comorbidity (85%). Half of patients sustained a sacral fracture after surgery from a posterior approach, while the others had anterior or anterior-posterior surgery. Mean time to fracture was 42 days with patients clinically presenting with new sacral pain (86%), radiculopathy (60%), or neurologic deficit (5%). Ultimately, 73% of patients underwent operative fixation often involving extension of the construct (75%) and fusion to the pelvis (69%). Men ( P = .02) and patients with new radicular pain or neurologic deficit ( P = .01) were more likely to undergo revision surgical treatment while women over 50 years of age were more likely to be treated conservatively ( P = .003). Conclusions: Spine surgeons should monitor for sacral insufficiency fracture as a source of new-onset pain in the postoperative period in patients with a short segment fusion to the sacrum. The recognition of this complication should prompt an assessment of bone health and management of underlying bone fragility.

The response of an embedded sphere in a viscoelastic medium excited by acoustic radiation force has been studied in both the time- and frequency-domains. This model is important because it can be used to characterize the viscoelastic properties of the medium by fitting the response to the theoretical model. The Kelvin–Voigt model has been used exclusively in these models. An extension to the previously reported models is described so that any viscoelastic rheological model can be used. This theoretical development describes the generalized embedded sphere response both in the time and frequency domains. Comparing the results from derivations in both domains showed very good agreement with a median absolute error (MAE) ranging from 0.0044 to 0.0072. Good agreement is demonstrated with finite element model simulations and the theory with a MAE of 0.006. Lastly, results for characterization of gelatin and rubber materials with the new theory are shown where the MAE values were used to determine which rheological model best describes the measured responses.