title: Bending of the Cotrel-Dubousset instrumentation after direct trauma: a case report.
abstract: METHODS
  Case report.
  
  
  OBJECTIVE
  To describe a fracture through the fusion mass of a spine that had been corrected previously with Cotrel-Dubousset rods. These rods had failed in bending after direct trauma.
  
  
  BACKGROUND
  Nine years after successful treatment of scoliosis with Cotrel-Dubousset instrumentation, the patient was in a motor vehicle accident and sustained a hyperextension spine injury with complete L1-L2 paraplegia and disruption of the fusion mass. The Cotrel-Dubousset instrumentation rods, which failed in bending, could not be corrected in situ, and the angulated segments had to be resected. The spine then became extremely unstable, and the patient consulted the authors for definitive stabilization.
  
  
  RESULTS
  The spine was stabilized by attaching the proximal and distal retained Cotrel-Dubousset instrumentation to supplemental rods in a "domino" fashion. Crosslinks were added to improve the torsional stability. Intraoperatively, the fracture was well reduced, and the fixation was stable. A posterolateral fusion was performed with allogenic bone graft.
  
  
  CONCLUSIONS
  Bent Cotrel-Dubousset instrumentation rods are still very strong and may not correct in situ.- If resection is required, the retained portions of Cotrel-Dubousset instrumentation can serve as attachments to restore stable fixation a "domino"technique.
authors.affiliation: Joseph Barnhart Department of Orthopedic Surgery, and the Department of Neurosurgery, Baylor College of Medicine, Houston, TX 77030, USA.
authors.forename: A
authors.initials: A
authors.lastname: Nana
authors.forename: Z
authors.initials: Z
authors.lastname: Gugala
authors.forename: R W
authors.initials: RW
authors.lastname: Lindsey
authors.forename: P M
authors.initials: PM
authors.lastname: Caram
authors.forename: J H
authors.initials: JH
authors.lastname: Dickson
mesh_terms: D000063:Accidents, Traffic; D000328:Adult; D001858:Bone Nails; D002574:Cervical Vertebrae / Q000293:injuries; D005260:Female; D006801:Humans; D016268:Internal Fixators; D004204:Joint Dislocations / Q000209:etiology; D008159:Lumbar Vertebrae / Q000000981:diagnostic imaging / Q000293:injuries*; D011859:Radiography; D016103:Spinal Fractures / Q000000981:diagnostic imaging / Q000209:etiology* / Q000601:surgery; D013123:Spinal Fusion / Q000295:instrumentation*