title: C7 pars fracture subadjacent to C7 pedicle screw instrumentation at the caudal end of a posterior cervical instrumentation construct.
abstract: We report a case of a C7 pars fracture subadjacent to C7 pedicle screw instrumentation at the caudal end of posterior cervical instrumentation construct. To date, posterior cervical instrumentation has been "off label"; however, the US Food and Drug Administration is considering approving label indication of such instrumentation for this common surgical practice. Complications related to the techniques are reported to be relatively low. We know of no previous reports of pars fractures occurring subadjacent to such instrumentation. A 43-year-old man underwent posterior C5-C7 instrumented fusion. Postoperatively, the patient experienced cervical spine injury after a mechanical fall down stairs. Work-up detected bilateral C7 pars fractures subadjacent to the posterior instrumentation construct. After we treated the pars fracture with distal extension of the posterior fusion to the level of T2, the patient progressed to union and marked improvement of initial clinical symptoms that was maintained 2.5 years after posterior instrumentation. To our knowledge, a C7 pars fracture subadjacent to posterior cervical instrumentation construct has not been reported. We hypothesize that the pars may have been vulnerable to fracture because of excessive bone resection during foraminotomy or decortication. This complication was successfully treated by extending the fusion caudally.
authors.forename: Andrea
authors.initials: A
authors.lastname: Halim
authors.affiliation: Department of Orthopedics and Rehabilitation, Yale University School of Medicine, New Haven, CT. jonathan.grauer@yale.edu.
authors.forename: Jonathan
authors.initials: J
authors.lastname: Grauer
mesh_terms: D000058:Accidental Falls; D000328:Adult; D001863:Bone Screws; D002574:Cervical Vertebrae / Q000293:injuries / Q000601:surgery; D006801:Humans; D008297:Male; D057068:Periprosthetic Fractures / Q000209:etiology / Q000601:surgery*; D016103:Spinal Fractures / Q000209:etiology / Q000601:surgery*; D013123:Spinal Fusion / Q000009:adverse effects* / Q000295:instrumentation; D013124:Spinal Injuries / Q000601:surgery