Spontaneus bilateral pedicle fracture 30 years after Harrington Instrumentation for idiopathic scoliosis: a case report

Abstract

Introduction: Spontaneous fractures of the spine are a common entity. They usually occur in older people with osteoporosis. This case is presented on account of its rarity. To the best of the authors' knowledge only one case of an osteoporotic pedicle fracture after Harrington Instrumentation has been described before.

Case presentation: We report the case of a 46-year-old Caucasian woman who underwent surgery due to idiopathic scoliosis with a Harrington Instrumentation (T4 to L3) 30 years ago. During the operation she was infected with hepatitis C while receiving erythrocyte concentrates and has suffered from liver cirrhosis since then. She presented with a sudden pain in her lower back and paraesthesia in both her legs but no other neurological symptoms. A computed tomography scan showed a bilateral pedicle fracture of L3 and an additional compression fracture of L4. In the first session we performed a dorsal stabilization with massive intraoperative bleeding and a postoperative failure of liver synthesis. In a second session an additional ventral augmentation was done. After the second operation she developed a hepatorenal syndrome. Both operations left the patient in a very critical state which led to a prolonged stay in the intensive care and rehabilitation unit. At her 12-month follow-up visit, she was free of complaints.

Conclusion: The un-physiological load of the spine after Harrington Instrumentation can lead to osteoporosis due to inactivity even in younger patients. Although these implants are not used anymore one should keep this possibility in mind when dealing with patients who have received Harrington rods in surgical procedures.

Figure 1

A computed tomography scan shows the fractured pedicles of L3

Figure 2

X-ray of the lumbar spine in anterior-posterior projection

Figure 3

X-ray of the lumbar spine in lateral projection showing the fractured pedicle

Figure 4

X-ray of the spine in anterior-ppsterior projection after dorsal spondylodesis

Figure 5

X-ray of the spine in lateral projection after dorsal spondylodesis showing the progressive thoracolumbar kyphosis and looming cutting-out of the pedicle screw in L1

Figure 6

X-ray of the spine in anterior-posterior projection one year after additional ventral augmentation

Figure 7

X-ray of the spine in lateral projection one year after additional ventral augmentation showing no further loss of correction