A rare case of instability and rod migration after C1–C2–C3–C4 screw fixation (clinical case and literature review)

Background. The rate of mechanical complications (screw system instability and hardware migration) associated with dorsal instrumental fixation of the cervical spine after injury ranges between 2 and 5 %. Implant migration, particularly of rods, following dorsal screw fixation of the cervical spine is a rare but potentially dangerous complication. Such complications can lead to severe neurological consequences and requires timely intervention. Aim. To analyze a clinical case of instability and migration of metal hardware following screw fixation of the C1–C2–C3–C4 segments in a patient with traumatic fractures of the C2 and C3 vertebra, and to review literature to identify risk factors and methods for preventing such complications. Material and methods. The study includes one clinical case of a patient who experienced complications – implant migration – after multilevel fixation of the cervical spine. Clinical examination, computed tomography (CT) were used to assess the condition of the patient and implants, along with a review of the literature on this issue. Results. The patient was diagnosed with instability of the metal hardware and migration of the rod into the posterior cranial fossa ( Fossa cranii posterior ) causing neurologic symptoms. A second surgical intervention was performed to remove the metal hardware. The literature review revealed that such cases are rare and require careful approach to selection of fixation methods and postoperative monitoring. Discussion. The analysis of the clinical case and the literature revealed possible causes of migration, including inadequate fixation and technical errors. Recommendations on prevention of such complications and patient management are proposed. Conclusion. Rare cases of instability and migration of the metal hardware following multilevel screw fixation of the cervical spine require personalized approach to diagnosis and treatment. Performing spinal fusion with strict adherence to surgical technique, increased awareness, and strict postoperative monitoring can reduce the risk of complications and improve treatment outcomes.