Pediatric chance fracture associated with pedicle screw use - A case report

Study Design. A previously undescribed clinic entity is presented, along with suggestions to prevent its reoccurrence. Objective. To identify a potential pitfall in the use of pedicle screw instrumentation in trauma cases. Also, to emphasize the need to identify and treat noncontiguous spinal fractures. Summary of Background Data. No previous cases have yet been described with this particular complication, which would be remedied easily with established methods. Pedicle screw instrumentation previously has been associated primarily with complications due to aberrant screw insertion and injury to adjoining tissues, or due to fracture of the construct itself in the absence of fusion formation. Methods. A 15-year-old girl suffered a traumatic T12-L1 fracture dislocation and paraplegia. After pedicle screw instrumentation, her apparently benign L3 fracture progressed to a severely displaced Chance fracture. This was repaired with caudal laminar hook compression instrumentation. Results. Postoperatively, at a 1-year follow-up, the patient's spinal deformity was completely alleviated, though she remains paraplegic. Conclusions. Unstable traumatic spinal injuries treated with pedicular instrumentation should have additional laminar hook compression 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.