Case Rep Orthop. 2020 Feb 24;2020:5824383. doi: 10.1155/2020/5824383. eCollection 2020.

Burley HEK, Ansari DS, von Glinski A, Goodmanson R, Schell B, Chapman JR, Oskouian RJ.

Abstract

This report presents an unusual case of instrumentation failure after posterior fixation of a C2 fracture and reviews currently available treatment alternatives. The patient, a 53-year-old female, initially presented to the emergency department at an outside facility with acute alcohol intoxication and acute neck pain following a fall from a ladder. CT demonstrated bilateral C2 pars fractures and unstable posteroinferior displacement of the posterior elements. She underwent an emergent C2 open-reduction internal fixation (ORIF) at the outside facility with 3.5 mm polyaxial synapse pedicle screws (DePuy Synthes, Switzerland). There were no known complications and the patient was discharged. Two years after the index operation, cervical CT scan at a different facility revealed that although the fracture was fully healed, bilateral tulip caps had detached from the pedicle screw heads at C2. All implants were removed without postoperative complications. Industry review of alternate lag screws approved for the cervical spine demonstrated that there is not currently an ideal implant for fixation of C2 fractures without fusion. Cannulated trauma screws, which are low profile and would have avoided the instrumentation failure seen here, are not currently FDA approved for the cervical spine.

Figure 1

Fracture of C2 pedicles shown with white arrows. Sagittal view (a) and axial view (b).

Figure 2

Radiographs of the cervical spine in extension (a) and flexion (b) display complete detachment of the tulip from the screw.

Figure 3

Erosion of the coupling portion of the tulip head from motion at the tulip-screw junction.

Figure 4

Healing of original C2 pedicle fractures shown with white arrows. Sagittal view (a) and axial view (b).

Tulip-Screw Head Disjunction from Posterior C2 Fracture Fixation Instrumentation.

Abstract