Path to Perdition: Lessons Learnt from Inadequate Fixation of an L5 Fracture

Abstract

AbstractPedicle screw fixation is a commonly performed operation following fractures of dorsal and lumbar spines. As neurosurgeons, our primary aim is decompression of neural structures and stabilization of the vertebral column. However, careful preoperative planning is imperative to restore the alignment of the spine in sagittal and coronal planes as otherwise implant failure and progressive deformity may result. Eleven years ago, I had operated on a 12-year-old child with an L5 fracture and cauda equina syndrome where no attempt was made to either do a corpectomy and reconstruct the body or reduce it by placing screws in the fractured segment or include additional levels in the construct. Over time he had only minimal improvement in neurological status. Unfortunately, there was sequential implant failure that led to eventual removal. The serial roentgenography in this case is described.