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Neurologic Injury After Insertion of Laminar Hooks During Cotrel-Dubousset Instrumentation

Been, Henk D., MD, PhD*; Kalkman, Cor J., MD, PhD; Traast, Han S., MD; Ongerboer de Visser, Bram W., MD, PhD

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Background Data Although the use of Cotrel-Dubousset (CD) instrumentation has improved results of operative treatment of scoliotic deformities, this technique may be associated with increased risk of neurologic injury.

Case Histories Two cases of neurologic complications immediately after insertion of lumbar laminar hooks during CD instrumentation for correction of scoliosis are reported.

Methods Between 1986 and 1992, the authors performed 220 CD instrumentations for various spinal deformities. All patients were monitored with posterior tibial nerve somatosensory cortical evoked potentials (PTN-SSEPs).

Conclusion These cases demonstrate that caution should be exercised during introduction of laminar hooks on the concave side during CD instrumentation for scoliotic deformities. Continuous neurophusiologic monitoring of spinal cord conduction may aid in early detection of local compression at the spinal cord or cauda equina level.

*Departments of Orthopaedic Surgery, Academic Hospital, University of Amsterdam, The Netherlands.

†Anesthesiology, Academic Hospital, University of Amsterdam, The Netherlands.

‡Clinical Neurophysiology, Academic Hospital, University of Amsterdam, The Netherlands.

© Lippincott-Raven Publishers.