A Case of Screw Extrusion through the Skin after Cervical Laminoplasty

Cervical laminoplasty is a well-established surgical approach for managing various cervical spine pathologies, including cervical spondylotic myelopathy, spinal canal stenosis, and ossification of the posterior longitudinal ligament. Among the available laminoplasty techniques, the use of Hydroxyapatite spacers secured with screws is common for maintaining the expanded interlaminar space. However, one potential complication is screw back-out, which, although recognized, has rarely been documented in the literature. We present a rare case of delayed screw migration culminating in skin perforation in a 76-year-old woman who underwent cervical laminoplasty for cervical spondylotic myelopathy. During the index procedure, Hydroxyapatite spacers were placed and secured with screws into the lamina. Seven years postoperatively, gradual subcutaneous migration of the screw from the lamina of the fourth cervical vertebra was observed, ultimately resulting in complete skin penetration 9 years after the initial surgery. The patient underwent surgical removal of the protruding screw along with surrounding granulation tissue. The surgical site was thoroughly irrigated with copious saline, and the wound was closed primarily with sutures. Postoperative recovery was uneventful. Stitches were removed on day 11 after confirming complete wound healing. This case underscores an exceptionally rare but clinically significant late complication of cervical laminoplasty with Hydroxyapatite spacers -complete screw extrusion through the skin. To our knowledge, this is the first documented case of its kind. The prolonged asymptomatic nature of screw migration in this patient highlights the importance of long-term surveillance following laminoplasty, even in the absence of clinical symptoms, to detect hardware-related complications at an early stage.