title: Late Fracture After Long Spinal Fusion for Idiopathic Scoliosis: A Case Report.
abstract: METHODS
  Case report.
  
  
  OBJECTIVE
  To report a case of late atraumatic fracture of a long spinal fusion for idiopathic scoliosis 37 years after removal of instrumentation and review the literature on this complication.
  
  
  BACKGROUND
  Late fracture of a long spinal fusion performed for idiopathic scoliosis is rare, with only several cases reported in the literature.
  
  
  METHODS
  The authors report a case of atraumatic fracture of a long fusion mass in a 55-year-old woman who underwent spinal fusion with Harrington rods at age 14 years with Harrington rod removal at age 18 years. She subsequently developed flat-back syndrome at age 49 years and underwent L3-4, L4-5, and L5-S1 Smith-Peterson osteotomies and posterolateral segmental instrumentation fusion from T12 to pelvis. She developed acute-onset mid-thoracic pain after a minor twisting injury without radiation or neurologic deficit, and was found on magnetic resonance imaging to have a fracture through the fusion mass at T6-7 with increased activity at this location on bone scan.
  
  
  RESULTS
  The patient failed conservative treatment with a high custom-molded brace and underwent posterior segmental spinal instrumentation and fusion from T2 to the previous instrumentation at L2 with autograft and allograft. She had immediate improvement of back pain postoperatively and has recovered well from the surgery.
  
  
  CONCLUSIONS
  Late fracture through a long fusion mass is a rare long-term complication of spine fusion for idiopathic scoliosis. In this case report, we report successful treatment of a fracture with a long lever arm of a solid posterior fused spine with posterior instrumented fusion multiple levels above and below the fracture.
authors.affiliation: Spine Surgery Division, Midwest Orthopaedics at Rush, 1611 West Harrison Street, Chicago, IL 60612, USA. Electronic address: Gregory.cvetanovich@gmail.com.
authors.forename: Gregory L
authors.initials: GL
authors.lastname: Cvetanovich
authors.affiliation: Spine Surgery Division, Midwest Orthopaedics at Rush, 1611 West Harrison Street, Chicago, IL 60612, USA; Department of Orthopaedic Surgery, University of Virginia, Charlottesville, VA 22908, USA.
authors.forename: Hamid
authors.initials: H
authors.lastname: Hassanzadeh
authors.affiliation: Spine Surgery Division, Midwest Orthopaedics at Rush, 1611 West Harrison Street, Chicago, IL 60612, USA.
authors.forename: Kevin
authors.initials: K
authors.lastname: Park
authors.affiliation: Spine Surgery Division, Midwest Orthopaedics at Rush, 1611 West Harrison Street, Chicago, IL 60612, USA.
authors.forename: Christopher J
authors.initials: CJ
authors.lastname: DeWald
keywords: Fusion-mass fracture; Idiopathic scoliosis; Instrumentation removal; Revision