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Occipital bone erosion induced by C1 pedicle screw as a late complication of atlantoaxial fixation: a case report and literature review

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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.

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Acknowledgements

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No funding was received for this case report.

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Authors and Affiliations

  1. Department of Orthopaedic Surgery, Karatsu Red Cross Hospital, 2430 Watada, Karatsu-city, Saga, 847-8588, Japan

    Ko Ikuta, Kazunari Sakamoto, Kensuke Hotta, Takahiro Kitamura, Hideyuki Senba & Satoshi Shidahara

Authors
  1. Ko Ikuta
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  2. Kazunari Sakamoto
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  3. Kensuke Hotta
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  4. Takahiro Kitamura
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  5. Hideyuki Senba
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  6. Satoshi Shidahara
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Contributions

K.I: made substantial contributions to the conception or design of the work; The acquisition, analysis, or interpretation of data; Drafted the work or revised it critically for important intellectual content; Approved the version to be published; agree to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved. K.S: made substantial contributions to the conception or design of the work; Drafted the work or revised it critically for important intellectual content; Approved the version to be published; Agree to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved. K.H: made substantial contributions to the conception or design of the work; Drafted the work or revised it critically for important intellectual content; Approved the version to be published; Agree to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved. T.K: made substantial contributions to the conception or design of the work; Drafted the work or revised it critically for important intellectual content; Approved the version to be published; agree to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved. H.S: made substantial contributions to the conception or design of the work; Drafted the work or revised it critically for important intellectual content; Approved the version to be published; Agree to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved. S.S: made substantial contributions to the conception or design of the work; Drafted the work or revised it critically for important intellectual content; Approved the version to be published; agree to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.

Corresponding author

Correspondence to Ko Ikuta.

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Ikuta, K., Sakamoto, K., Hotta, K. et al. Occipital bone erosion induced by C1 pedicle screw as a late complication of atlantoaxial fixation: a case report and literature review. Spine Deform 9, 621–625 (2021). https://doi.org/10.1007/s43390-020-00222-1

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  • DOI: https://doi.org/10.1007/s43390-020-00222-1

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