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

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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References

  1. 1.

    Alshafai NS, Kramarz A, Behboudi M (2019) Insights into the past and future of atlantoaxial stabilization techniques. Acta Neurochir Suppl 125:265–271

    Article  Google Scholar 

  2. 2.

    Kobets AJ, Nakhla J, Geland Y, Tabaddor K, Houten JK (2019) Occipital erosion and pain from excess superior rods as a complication of atlantoaxial fusion. Open Sci Publ J Radiol 1:1–3 (1000101)

    Google Scholar 

  3. 3.

    Arizumi F, Moriyama T, Tachibana T, Maruo K, Inoue S, Manabe T, Yoshiya S (2015) Erosion in the occipital bone caused by the fixation instrument used for posterior atlantoaxial fusion -report of 4 cases-. Springer Plus 4:137

    Article  Google Scholar 

  4. 4.

    Fung M, Frydenberg E, Barnsley L, Chaganti J, Steel T (2018) Clinical and radiological outcomes of image guided posterior C1–C2 fixation for atlantoaxial osteoarthritis (AAOA). J Spine Surg 4:725–735

    Article  Google Scholar 

  5. 5.

    Harms J, Melcher RP (2001) Posterior C1–C2 fusion with polyaxial screw and rod fixation. Spine 26:2461–2471

    Article  Google Scholar 

  6. 6.

    Huang DG, Hao DJ, He BR, Wu QN, Liu TJ, Wang XD, Guo H, Fang XY (2015) Posterior atlantoaxial fixation: a review of all techniques. Spine J 15:2271–2281

    Article  Google Scholar 

  7. 7.

    Lee SH, Kim ES, Eoh W (2013) Modified C1 lateral mass screw insertion using a high entry point to avoid postoperative occipital neuralgia. J Clin Neurosci 20:162–167

    Article  Google Scholar 

  8. 8.

    Nakao Y, Shimokawa N, Morisako H, Tsukazaki Y, Terada A, Nakajo K, Fu Y (2014) Late complication of surgically treated atlantoaxial instability: Occipital bone erosion induced by protruded fixed titanium rod: a case report. J Chiroprac Med 13:278–281

    Article  Google Scholar 

  9. 9.

    Oh CH, Ji GY, Seo HS, Yoon SH, Hyun D, Park HC (2014) Repeated complication following atlantoaxial fusion: a case report. Korean J Spine 11:7–11

    Article  Google Scholar 

  10. 10.

    Resnick DK, Laspsiwala S, Trost GR (2002) Anatomic suitability of the C1–C2 complex for pedicle screw fixation. Spine 27:1494–1498

    Article  Google Scholar 

  11. 11.

    Tan M, Wang H, Wang Y, Zhang G, Yi P, Li Z, Wei H, Yang F (2003) Morphometric evaluation of screw fixation in atlas via posterior arch and lateral mass. Spine 28:888–895

    PubMed  Google Scholar 

  12. 12.

    Yeom JS, Kafle D, Nguyen NQ, Noh W, Park KW, Chang BS, Lee CK, Riew KD (2012) Routine insertion of the lateral mass screw via the posterior arch for C1 fixation: feasibility and related complications. Spine J 12:476–483 (11)

    Article  Google Scholar 

Download references

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No funding was received for this case report.

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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.

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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 (2020). https://doi.org/10.1007/s43390-020-00222-1

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Keywords

  • Atlantoaxial fixation
  • C1 pedicle screw
  • Case report
  • Occipital bone erosion
  • Surgical complication
  • Cervical alignment