Occipital bone erosion induced by C1 pedicle screw as a late complication of atlantoaxial fixation: a case report and li
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CASE REPORT
Occipital bone erosion induced by C1 pedicle screw as a late complication of atlantoaxial fixation: a case report and literature review Ko Ikuta1 · Kazunari Sakamoto1 · Kensuke Hotta1 · Takahiro Kitamura1 · Hideyuki Senba1 · Satoshi Shidahara1 Received: 28 April 2020 / Accepted: 28 September 2020 © Scoliosis Research Society 2020
Abstract Purpose The objective of this case report is to highlight occipital bone erosion as an unusual late complication of C1-C2 instrumented fixation. Case presentation A 60-year-old man of a displaced Anderson type II odontoid fracture was surgically treated by C1-C2 pedicle screw fixation. Occipital bone erosions, caused by a repeat irritation of the end of rod to the occipital bone, were detected on multiplane reconstructed computed tomography at 3 months after surgery. The lesion progressed over time with increasing the C2 anteversion on radiological evaluations. Eventually, the bony shell had been reactively formed around the protruded screw-rod construct and the Oc-C1 segment had been spontaneously stabilized. Fortunately, he had experienced no symptoms caused by the lesion at 5-year follow-up. Conclusion The occipital bone erosion is an unusual late complication in C1-C2 posterior fixation using C1 pedicle screw. The increasing occipital-C1 lordosis compensating for the great C2 anteversion (high C2 slope) was related to the progression of the lesion. In C1-C2 pedicle screw fixation, surgeons should recognize a possibility of this complication and realize a relation between the occurrence of the lesion and the sagittal alignment of the cervical spine to take measures to avoid the complication. Keywords Atlantoaxial fixation · C1 pedicle screw · Case report · Occipital bone erosion · Surgical complication · Cervical alignment
Introduction Recently, posterior C1-C2 fixation techniques have improved considerably [1, 6]. C1 lateral mass screw (LMS) and C2 pedicle screw (PS) fixation connected by top-loading rod has become increasingly popular to treat atlantoaxial instability as it provides excellent rigidity and requires no insertion of hardware into the spinal canal [5]. Nonetheless, the C1 LMS insertion technique is technically demanding and has a risk of damages to large venous plexuses in the lateral gutter and the C2 nerve roots. The irritation in the C2 nerve root induces postoperative occipital neuralgia. Consequently, some modified techniques, such as C1 notching technique * Ko Ikuta kou‑[email protected] 1
Department of Orthopaedic Surgery, Karatsu Red Cross Hospital, 2430 Watada, Karatsu‑city, Saga 847‑8588, Japan
[7, 12] and C1 PS technique [10, 11], have been developed. Meanwhile, there are some reports on postoperative occipital bone erosion (OBE) as a rare late complication of the C1 LMS [2–4, 8, 9]. The purpose of this case report is to present a case with OBEs induced by C1 PS after C1-C2 fixation and review the literatures.
Case presentation A 60-year-old man fell down and sustained Anderson type II odontoid fracture (Figs. 1a, 2a).
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