Dumpa Srikanth Reddy, Aiyer Siddharth N, Rajoli Sreekanth Reddy, Shetty Ajoy Prasad, Rajasekaran S
Department of Spine Surgery, Ganga Hospital, 313, Mettupalayam Road, Coimbatore, India.
Eur Spine J. 2018 Jul;27(Suppl 3):264-269. doi: 10.1007/s00586-017-5117-4. Epub 2017 May 8.
To document a rare complication of a delayed 'chance fracture pattern'-type injury through the proximal end of a pedicle screw construct in the clinical scenario of skeletal fluorosis.
A 72-year-old man with fluorosis presented following a fall which resulted in a T12-L1 fracture. Investigations revealed an unstable three-column injury, so the patient was treated with surgical stabilisation using pedicle screw fixation from T11 to L2. He presented 1 month following surgery with worsening back pain. Investigations revealed a fracture through T11 in a 'chance fracture pattern' along the pedicle screw tracts at the proximal end of the construct. An extension of fixation was performed proximally to T8 and he made an uneventful recovery showing fusion at 20-month follow-up.
Complication of delayed pedicle fractures, in a 'chance fracture pattern' at the ends of a pedicle screw fixation constructs are a rarely reported in the literature. The occurrence of such a complication in a hyperostotic spine associated with fluorosis makes this a unique clinical scenario which is previously unreported to the best of our knowledge.
This report highlights a very rare complication of chance fracture pattern injury in the clinical scenario of fluorosis. A hyperostotic stiff spine, poor quality of bone and extension of pedicle screw tracts to anterior cortex during primary surgery may have resulted in the occurrence of this rare complication.
记录在骨骼氟中毒临床情况下，经椎弓根螺钉固定结构近端发生的罕见迟发性“Chance骨折型”损伤并发症。
一名72岁氟中毒男性患者因跌倒导致T12-L1骨折。检查发现为不稳定的三柱损伤，因此对患者进行了手术稳定治疗，采用从T11至L2的椎弓根螺钉固定。术后1个月，他因背痛加重前来就诊。检查发现，在固定结构近端，沿椎弓根螺钉通道出现了T11的“Chance骨折型”骨折。遂将固定范围近端延长至T8，患者恢复顺利，20个月随访时显示融合良好。
椎弓根螺钉固定结构末端出现“Chance骨折型”迟发性椎弓根骨折并发症，在文献中鲜有报道。在与氟中毒相关的骨质增生性脊柱中发生这种并发症，据我们所知，这是一种此前未报道过的独特临床情况。
本报告强调了在氟中毒临床情况下，Chance骨折型损伤这一极为罕见的并发症。骨质增生僵硬的脊柱、骨质质量差以及初次手术时椎弓根螺钉通道延伸至前皮质，可能导致了这种罕见并发症的发生。
