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.