Late Complication of Surgically Treated Atlantoaxial Instability: Occipital Bone Erosion Induced by Protruded Fixed Titanium Rod: A Case Report

Abstract

Objective: Polyaxial screw-rod fixation of C1-C2 is a relatively new technique to treat atlantoaxial instability, and there have been few reports in the literature outlining all possible complications. The purpose of this case report is to present the occurrence and management of occipital bone erosion induced by the protruded rostral part of a posterior atlantoaxial screwrod construct causing headache. Clinical Features: A 70-year-old Asian man with rheumatoid arthritis initially presented to our institution with atlantoaxial instability causing progressive quadraparesis and neck pain. Intervention and Outcome: Posterior atlantoaxial instrumented fixation using C1 lateral mass screws in conjunction with C2 pedicle screws was performed to stabilize these segments. Postoperatively, the patient regained the ability to independently walk and had no radiographic evidence of instrumentation hardware failure and excellent sagittal alignment. However, despite a well-stabilized fusion, the patient began to complain of headache during neck extension. Follow-up imaging studies revealed left occipital bone erosion induced by a protruded titanium rod fixed with setscrews. During revision surgery, the rod protrusion was modified and the headaches diminished. Conclusion: This case demonstrates that occipital bone erosion after posterior atlantoaxial fixation causing headache may occur. The principal cause of bone erosion in this case was rod protrusion. Although posterior atlantoaxial fixation using the screw-rod system was selected Journal of Chiropractic Medicine (2014) 13, 278-281 to manage atlantoaxial instability because it has less complications than other procedures, surgeons should pay attention that the length of the rod protrusion should not exceed 2 mm.

Design a novel integrated screw for minimally invasive atlantoaxial anterior transarticular screw fixation: a finite element analysis

“…However, this surgical procedure is difficult and involves high risks, which are unavoidable for many spinal surgeons. Posterior surgery is prone to damage of the vertebral artery and nerves [25], resulting in severe consequences such as massive haemorrhage of the vertebral artery, cerebral infarction and hemiplegia caused by vertebral artery embolism, and dyspnoea resulting from central nervous system damage; in severe cases, the life of the patient may be in danger [26,27]. Some cases involve difficulties and risks when using the posterior approach, such as the abnormal development and pathway of the vertebral artery [28][29][30] and congenital or iatrogenic absence of the bony structure of the atlantoaxial vertebra pedicle [31,32], and the atlantoaxial complex can be more safely fused through the anterior approach.…”

Design a novel integrated screw for minimally invasive atlantoaxial anterior transarticular screw fixation: a finite element analysis

“…The key to solving this problem is to fuse the atlantoaxial complex by surgery [20] so that the atlantoaxial structure can be stabilised and nerve compression can be relieved. resulting from central nervous system damage; in severe cases, the life of the patient may be in danger [24,25]. Some cases involve difficulties and risks when using the posterior approach, such as the abnormal development and pathway of the vertebral artery [26][27][28] and congenital or iatrogenic absence of the bony structure of the atlantoaxial vertebra pedicle [29,30], and the atlantoaxial complex can be more safely fused through the anterior approach.…”

Design a novel integrated screw for minimally invasive atlantoaxial anterior transarticular screw fixation: a finite element analysis

“…However, this surgical procedure is difficult and involves high risks, which are unavoidable for many spinal surgeons. Posterior surgery is prone to damage of the vertebral artery and nerves [23], resulting in severe consequences such as massive haemorrhage of the vertebral artery, cerebral infarction and hemiplegia caused by vertebral artery embolism, and dyspnoea resulting from central nervous system damage; in severe cases, the life of the patient may be in danger [24,25]. Some cases involve difficulties and risks when using the posterior approach, such as the abnormal development and pathway of the vertebral artery [26][27][28] and congenital or iatrogenic absence of the bony structure of the atlantoaxial vertebra pedicle [29,30], and the atlantoaxial complex can be more safely fused through the anterior approach.…”