PEDIATRIC CHANCE FRACTURE ASSOCIATED WITH PEDICLE SCREW USE - A CASE-REPORT

Study Design. A previously undescribed clinic entity is presented, alo ng with suggestions to prevent its reoccurrence. Objective. To identif y a potential pitfall in the use of pedicle screw instrumentation in t rauma cases. Also, to emphasize the need to identify and treat noncont iguous spinal fractures. Summary of Background Data. No previous cases have yet been described with this particular complication, which woul d be remedied easily with established methods. Pedicle screw instrumen tation previously has been associated primarily with complications due to aberrant screw insertion and injury to adjoining tissues, or due t o fracture of the construct itself in the absence of fusion formation. Methods. A 15-year-old girl suffered a traumatic T12-L1 fracture disl ocation and paraplegia. After pedicle screw instrumentation, her appar ently benign L3 fracture progressed to a severely displaced Chance fra cture. This was repaired with caudal laminar hook compression instrume ntation. Results. Postoperatively, at a 1-year follow-up, the patient' s spinal deformity was completely alleviated, though she remains parap legic. Conclusions. Unstable traumatic spinal injuries treated with pe dicular instrumentation should have additional laminar hook compressio n configuration reinforcement at the ends of the constructs to prevent further stress-induced injury from the screws alone. Instrumentation constructs should not end at even minimally fractured levels.