Abstract
BACKGROUNDAtlantoaxial sublaminar wiring has many known complications related to hardware failure, but intracranial hemorrhage is a rare complication.OBSERVATIONSA 61-year-old female patient with prior atlantoaxial sublaminar wiring for odontoid fracture nonunion experienced decreased level of consciousness due to a subarachnoid and subdural hemorrhage of the posterior fossa with intraventricular extension and hydrocephalus. Rupture of the sublaminar wire with intramedullary protrusion was the cause of the hemorrhage. The patient was treated with ventriculostomy for hydrocephalus and occipital cervical fusion for spinal instability, along with removal of the broken wire and drainage of a hematoma.LESSONSThis uncommon cause of intracranial hemorrhage highlights an additional risk of atlantoaxial sublaminar wiring compared with other atlantoaxial fusion techniques. In addition, this case suggests cervical instrumentation failure as a differential diagnosis of subarachnoid and subdural hemorrhage of the posterior fossa when a history of prior instrumentation is known.
Highlights
Atlantoaxial sublaminar wiring has many known complications related to hardware failure, but intracranial hemorrhage is a rare complication
We describe a rare but serious and potentially fatal complication of atlantoaxial sublaminar wiring failure with an atypical presentation of a progressively comatose patient with posterior fossa and upper spinal subdural and subarachnoid hemorrhage resulting in acute hydrocephalus
We review the literature of spinal hardware failure in relation to subarachnoid hemorrhage
Summary
Atlantoaxial sublaminar wiring has many known complications related to hardware failure, but intracranial hemorrhage is a rare complication. LESSONS This uncommon cause of intracranial hemorrhage highlights an additional risk of atlantoaxial sublaminar wiring compared with other atlantoaxial fusion techniques. This case suggests cervical instrumentation failure as a differential diagnosis of subarachnoid and subdural hemorrhage of the posterior fossa when a history of prior instrumentation is known. We describe a rare but serious and potentially fatal complication of atlantoaxial sublaminar wiring failure with an atypical presentation of a progressively comatose patient with posterior fossa and upper spinal subdural and subarachnoid hemorrhage resulting in acute hydrocephalus. We review the literature of spinal hardware failure in relation to subarachnoid hemorrhage
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