Neurological deterioration due to cord and cauda compression at the site of laminar hook insertion: Immediate complication of Texas Scottish Rite Hospital instrumentation for lumbar vertebral fracture

We report an unusual case of a 71-year-old female patient with incomplete paraplegia who experienced neurological deterioration a few hours after the insertion of TSRH (Texas Scottish Hospital Rite) laminar hooks for correction and stabilisation of a fracture of the first lumbar vertebra. Combined CT-myelography revealed significant encroachment of the hooks on the spinal canal, associated with compression of the spinal cord and cauda. The hardware was removed a few hours after the first operation. Two weeks after the revision operation the neurological picture improved. Three months postoperatively the patient died from lung embolism while she was improving neurologically. This case demonstrates that caution should be exercised during the introduction of laminar hooks for thoracolumbar fractures in elderly patients with degeneration of the lumbar spine and stenosis. To avoid such problems careful attention should be paid to appropriate hook selection and safe hook anchorage during fixation and distraction-compression manoeuvres.