Late complication of surgically treated atlantoaxial instability: occipital bone erosion induced by protruded fixed titanium rod: a case report.

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 screw-rod 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 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.

Radical excision combined with instrumented fixation in the management of thoracic epidural angiolipoma: a case report.

INTRODUCTION: Spinal angiolipoma is a benign uncommon neoplasm composed of mature lipocytes admixed with abnormal blood vessels. They account for only 0.04% to 1.2% of all spinal tumors. We present a case of thoracic epidural angiolipoma treated by combining radical resection with instrumented spinal fixation, without any surgical complication. CASE PRESENTATION: A 32-year-old Asian woman presented with dorsal epidural angiolipoma at the upper-thoracic level. She had a seven-month history of gradually worsening weakness and numbness in her lower extremities. Imaging studies of her thoracic spine demonstrated a heterogeneously well-enhancing mass, located in her posterior epidural space without surrounding bone erosion at the upper thoracic level. We also observed compression of her thoracic cord. During surgery, a reddish-gray, highly vascularized mass was excised. Her facet joints had to be resected to expose the part migrating into the intervertebral foramen. Because there was concern regarding the stability of her thoracic spine, we performed spinal fixation using pedicle screws. Histopathological study of the surgical specimen showed a typical angiolipoma. CONCLUSION: Angiolipomas can be radically excised with good prognosis. Surgical removal is the preferred treatment for spinal angiolipoma, and the prognosis after surgical management is very good. Although outcomes remained favorable despite incomplete resections in a number of spinal angiolipoma, complete removal is preferred. We successfully achieved total resection without any surgical complication by combining radical resection with instrumented spinal fixation.

Traumatic subarachnoid hemorrhage associated with acupuncture.

Subarachnoid hemorrhage as a complication of acupuncture has been reported in only a few cases. We report another case and discuss the implications of subarachnoid hemorrhage following acupuncture. Although acupuncture has traditionally been thought to be relatively safe, physicians should be aware that it may be a cause of intracranial hemorrhage.