A bony Chance fracture through L1 following posterior spinal fusion for adolescent idiopathic scoliosis: a case report


Study design

Case report.


Instrumented posterior fusion using pedicle screws has been the mainstay of the surgical correction of adolescent idiopathic scoliosis since it was popularised by Roy-Camille in the 1970s. The aim of this case report is to describe the occurrence and salvage of an L1 chance fracture occurring through the lower instrumented vertebra following pedicle screw placement for posterior spinal instrumented fusion in the treatment of adolescent idiopathic scoliosis (AIS).

Case report

A 15-year-old female patient underwent T2–L1 posterior instrumented fusion for a Lenke 1b deformity. The selection of fusion levels was made based upon standing and bending radiographs which showed a non-structural lumbar curve. Early recovery was uneventful. At 6 months post-operatively, the patient reported new deformity and pain. A chance fracture at L1 was diagnosed and subsequent extension of instrumentation to L3 was carried out. Final post-operative recovery was uneventful and the patient returned to an active lifestyle.


Several factors can contribute to the occurrence of a fracture through an instrumented pedicle. This case shows that there must be due consideration of the small pedicle at L1 when it is chosen as the LIV.

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Author information




BR: acquisition and analysis of data, drafted the manuscript, and approved the manuscript. SK: acquisition of data, critically revised the manuscript, and approved the manuscript. DL: critically revised the manuscript, and approved the manuscript. SL: conceived study, critically revised the manuscript, and approved the manuscript.

Corresponding author

Correspondence to Brett Rocos.

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Conflict of interest

BR: none, SK: none, DL: none, and SL: none.

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No copyrighted material was included in this study. Patient’s identity has not been revealed. Being a single-case study, it is exempt from institutional review board approval.

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All identifiable details have been removed from the report. Informed consent is, therefore, not required.

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Rocos, B., Kato, S., Lebel, D. et al. A bony Chance fracture through L1 following posterior spinal fusion for adolescent idiopathic scoliosis: a case report. Spine Deform (2021). https://doi.org/10.1007/s43390-020-00257-4

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  • Scoliosis
  • Deformity
  • Correction
  • Adolescent idiopathic scoliosis