Clinical expertise by surgeon: a (b)(6) patient: initial intervention: correction by thoraco lumbar instrumentation with pedicle screwing.Limit of upper end in middle thoracic by 2 jazz claw hooks, no protection of upper thoracic spine.Disassembly of the 2 jazz claw took place with probable removal of the hooks placed in first intention.The assumptions made are as follows: primary cause: fracture of the last screwed vertebra and the supra vertebra causing a local kyphosis, and consequently the pull out of the jazz claw.Secondary cause: the jazz claw positioned in the middle thoracic are not used in their maximum configuration (strong mechanical constraints on a kyphosed and stiff spine) secondary cause: stopping the instrumentation in the middle thoracic involves the risk of fracture on osteoporotic spine above the most rigid instrumentation (here pedicular screw) conclusions : this type of instrumentation (jazz claw) does not seem to be the dislodging cause.It seems that the upper level of the instrumentation in middle thoracic spine with hard mechanical constraints, osteoporotic and poor bone quality are the causes.It would have been better to fix the instrumentation on the upper thoracic spine.This was performed during the second surgery.This was the best solution and could have been performed on the first intention with jazz claw with less constraints on the bones.Device discarded.
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