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Sublaminar wire migration into the medulla oblongata: a case report
Alex Koziarz1, Mohammed Aref1, Brian Vinh1
11Division of Neurosurgery, Department of Surgery, 2Division of Neuroradiology, Department of Radiology, McMaster University, Hamilton, Ontario, Canada.
Journal of Spine Surgery (Hong Kong)
|July 27, 2017
Summary
Wire migration after Gallie fusion can cause serious neurological issues. Consider this complication in patients with new symptoms post-surgery.
Area of Science:
- Neurosurgery
- Spinal Fusion
- Neurological Complications
Background:
- Atlantoaxial fusion aims for solid C1-C2 joint stability.
- Sublaminar wiring techniques carry risks of neural structure injury.
- Gallie fusion is a historical C1-C2 fusion method.
Observation:
- A patient with rheumatoid arthritis presented with ataxia and dysphagia 10 years post-Gallie fusion.
- CT scan revealed a dislodged Gallie fusion wire migrated into the medulla oblongata.
- Initial surgery involved foramen magnum decompression, C1 laminectomy, and wire removal.
Findings:
- Post-decompression, occipital screws dislodged within 6 months.
- Revision surgery with new occipital screws improved gait.
- The migrated wire was successfully removed.
Implications:
- Wire migration is a critical differential diagnosis for delayed neurological deficits after sublaminar wire fusion.
- Careful patient selection and monitoring are crucial for sublaminar wire techniques.
- This case highlights the long-term risks associated with older spinal fusion methods.
