Failure of posterior titanium atlantoaxial cable fixation

Area of Science:

• Neurosurgery
• Orthopedic Surgery
• Spinal Fusion Techniques

Background:

• Operative treatment for rotatory atlantoaxial instability is debated.
• Titanium cable fixation is preferred over wire for interlaminar fixation due to biomechanical advantages.
• Cable fixation, while improved, carries a risk of fatigue failure.

Observation:

• This case study details a rare instance of titanium cable fatigue failure.
• The failure occurred in a patient undergoing posterior C1-C2 fusion for rotatory atlantoaxial instability.
• The fractured cable migrated into the patient's spinal canal.

Findings:

• The study reports the first known case of titanium cable fatigue failure in atlantoaxial instability fixation.
• Surgical revision involved removing the fractured cable and repairing pseudarthrosis.
• Successful salvage was achieved using atlantoaxial screws.

Implications:

• Interlaminar fixation using cables or wires is susceptible to failure and spinal canal migration.
• Transarticular screw fixation is a viable salvage method for failed cable or wire fixation.
• This highlights the need for careful monitoring and consideration of alternative fixation methods.