Bending of the Cotrel-Dubousset instrumentation after direct trauma - A case report

Study Design. Case report. Objectives. To describe a fracture through the fusion mass of a spine that had been corrected previously with Cotrel-Dubousset rods. These rods had fa iled in bending after direct trauma. Summary of Background Data. Nine years after successful treatment of scolio sis with Cotrel-Dubousset instrumentation, the patient was in a motor vehic le accident and sustained a hyperextension spine injury with complete L1-L2 paraplegia and disruption of the fusion mass. The Cotrel-Dubousset instrum entation rods, which failed in bending, could not be corrected in situ, and the angulated segments had to be resected. The spine then be extremely uns table, and the patient consulted the authors for definitive stabilization. Results. The spine was stabilized by attaching the proximal and distal reta ined Cotrel-Dubousset instrumentation to supplemental rods in a "domino" fa shion. Crosslinks were added to improve the torsional stability. Intraopera tively, the fracture was well reduced, and the fixation was stable. A poste rolateral fusion was performed with allogenic bone graft. Conclusion. Bent Cotrel-Dubousset instrumentation rods are still very stron g and may not correct in situ. If resection is required, the retained porti ons of Cotrel-Dubousset instrumentation can serve as attachments to restore stable fixation a "domino" technique.