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Neglected Percutaneous Rod Extrusion Following Posterior Occipitocervical Instrumentation: A Case Report

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by

Vishnu
in

Introduction

Surgical complications related to spinal instrumentation are rare but can have significant implications for patient outcomes. This case report highlights a unique instance of a percutaneous rod extrusion following posterior occipitocervical (OC) instrumentation, a complication not previously reported in medical literature. The findings underscore the need for rigorous postoperative follow-ups to detect and manage implant failures effectively.

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Case Summary

Patient Background

A 56-year-old patient was admitted with necrotizing fasciitis and a generalized septic condition, leading to multiple orthopedic surgeries. Among the complications was the development of an epidural abscess at the occipitocervical junction, necessitating posterior OC instrumentation using an occipital plate, screws, and bilateral rods.

Implant Failure and Rod Extrusion

  • 2-Year Follow-Up: Imaging revealed bilateral rod fractures at the C1/2 level.
  • Patient Non-Compliance: Despite a recommendation for revision surgery, the patient did not return to the clinic.
  • 4-Year Follow-Up: The patient reported finding a small metal wire on his pillow months earlier, later identified as an extruded rod. Remarkably, the patient experienced an improved range of motion without significant pain.

Key Takeaways

  • Implant failure in posterior OC fusion is rare but possible.
  • Percutaneous rod extrusion had not been documented in prior cases of OC surgery.
  • The patient, despite implant loss, showed no significant instability or pain, leading to a non-surgical management approach.

Clinical Implications

Understanding the Risk of Implant Failures

Research suggests that implant failure rates range from 7.9% to 29.6% in OC fusion procedures, often requiring revision surgery. External organizations such as the American Academy of Orthopaedic Surgeons (AAOS) emphasize the importance of post-surgical follow-ups to detect and address such complications early.

Access the Full Study

Read the full case study at https://doi.org/10.29328/journal.acr.1001063.

Recommended Reading

Conclusion & Call-to-Action

This case highlights the need for careful long-term follow-up in OC instrumentation. While implant failures typically necessitate revision surgery, some patients may experience positive outcomes despite extrusion.

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