NEUROLOGIC INJURY AFTER INSERTION OF LAMINAR HOOKS DURING COTREL-DUBOUSSET INSTRUMENTATION

Background Data. Although the use of Cotrel-Dubousset (CD) instrumenta tion has improved results of operative treatment of scoliotic deformit ies, this technique may be associated with increased risk of neurologi c injury. Case Histories. Two cases of neurologic complications immedi ately after insertion of lumbar laminar hooks during CD instrumentatio n for correction of scoliosis are reported. Methods. Between 1986 and 1999, the authors performed 220 CD instrumentations for various spinal deformities. All patients were monitored with posterior tibial nerve somatosensory cortical evoked potentials (PTN-SSEPs). Conclusion. Thes e cases demonstrate that caution should be exercised during introducti on of laminar hooks on the concave side during CD instrumentation for scoliotic deformities. Continuous neurophysiologic monitoring of spina l cord conduction may aid in early detection of local compression at t he spinal cord or cauda equina level.