Delayed myelopathy after remote C1-2 sublaminar wire fixation: illustrative case

Atlantoaxial sublaminar wiring complications, both early and delayed, have been documented. However, delayed neurological compromise 27 years after successful fusion is a rare but possible occurrence.

A 76-year-old male, who had undergone C1-2 sublaminar wire fusion for atlantoaxial instability in 1995, presented with symptoms of progressive right arm weakness, falls, and incontinence of bowel and bladder over a 1-week period. Initial imaging workup revealed bowing of the C1-2 sublaminar wires resulting in cervical spinal cord compression and T2-weighted signal changes. A C1-2 laminectomy was performed to remove the wires and decompress the spinal cord with improvement in the patient's neurological status.

This rare case highlights the potential for delayed cervical myelopathy and cord compression from sublaminar wires, even after a successful fusion. In patients with a history of sublaminar wiring who experience new neurological deficits, it is essential to evaluate the hardware for migration.