Pishnamaz et al. Journal of Medical Case Reports 2012, 6:98 http://www.jmedicalcasereports.com/content/6/1/98 C A S E R E P O R T JOURNAL OF MEDICAL CASE REPORTS Open Access Low back pain during pregnancy caused by a sacral stress fracture: a case report Miguel Pishnamaz*, Richard Sellei, Roman Pfeifer, Philipp Lichte, Hans C Pape and Philipp Kobbe Abstract Introduction: Sacral stress fractures are a rare but well known cause of low back pain. This type of fracture has also been observed as a postpartum complication. To date, no cases of intrapartum sacral stress fractures have been described in the literature. Case presentation: We report the case of a 26-year-old Caucasian European primigravid patient (30 weeks and two days of gestation) who presented to our outpatient clinic with severe low back pain that had started after a downhill walk 14 days previously. She had no history of trauma. A magnetic resonance imaging scan revealed a non-displaced stress fracture of the right lateral mass of her sacrum. Following her decision to opt for non- operative treatment, our patient received an epidural catheter for pain control. The remaining course of her pregnancy was uneventful and our patient gave birth to a healthy child by normal vaginal delivery. Conclusions: We conclude that a sacral stress fracture must be considered as a possible cause of low back pain during pregnancy. Introduction Although sacral stress fractures are uncommon, they are a well-known cause of low back pain, especially in athletes [1-5]. The underlying pathology of stress fractures is either a weakened bone or an unusually high load that normal bone is unable to withstand [6]. The latter has been cited by several authors as the cause of postpartum sacral frac- tures occurring during the course of childbirth [7-10]. Usually, the fracture is diagnosed by magnetic resonance imaging (MRI), which shows a vertical fracture line with surrounding osseous edema. This fracture is particularly challenging during pregnancy since adequate analgesic control is complicated by drug interactions with the fetus, as well as the continued load imposing stress on the sacrum over the course of the pregnancy. To the best of our knowledge, this case is the first report of an intrapar- tum sacral stress fracture and outlines the difficulties and limitations of pain control in these patients. Case presentation A 26-year-old Caucasian European primigravid patient (30 weeks plus two days of gestation) was transferred * Correspondence: mpishnamaz@ukaachen.de Department of Orthopedic and Trauma Surgery, University of Aachen Medical Center, 30 Pauwels Street, 52074 Aachen, Germany from a local area hospital with severe low back pain. She first experienced slight discomfort over her bilateral iliosacral joints while walking downhill 14 days pre- viously. She reported that water exercises gave her com- plete pain relief. Three days after the initial discomfort, she exacerbated the condition and experienced severe pain while exiting the passenger seat of her car. The pain was described as radiating from the right side of her lower back to the back side of her knee, and being electric in character. At that point, she was unable to walk independently and was admitted to the hospital for pain management with oral paracetamol. On admission to our hospital, a clinical examination revealed a healthy young woman with a height of 162 cm and a weight of 56 kg. She had gained 6 kg during her pregnancy. She had previously run one hour daily until approximately 12 months before her pregnancy. She denied any drug, alcohol or nicotine consumption. She had thus far had an uncomplicated pregnancy. Upon admission, a fetal weight of 1,400 g was estimated. Our patient had a temperature of 38.5°C and elevated inflammation parameters, with a C-reactive protein level of 95 mg/L (reference range, < 5 mg/L) and a white blood cell count of 13.6 G/l (reference range 4.3 to 10 G/l). Thrombosis was ruled out by color-coded Doppler © 2012 Pishnmaz et al; licensee BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.