Failure of posterior titanium atlantoaxial cable fixation

Abstract

Background context: The operative treatment of rotatory atlantoaxial instability remains controversial. The use of cable fixation has largely replaced the use of wire for interlaminar fixation. Although cable fixation offers biomechanical advantages over wire fixation, it is still at risk of fatigue failure. The authors were unable to locate any published reports of fatigue failure of titanium cables in the fixation of atlantoaxial instability. Purpose: The purpose of this case study is to describe an unusual case of fatigue failure of a titanium cable used to aid in atlantoaxial fusion for the treatment of rotatory atlantoaxial instability. Study design: Case study. Methods: We reviewed the medical records and X-rays of a patient with rotatory atlantoaxial instability treated with posterior C1–C2 fusion and atlantoaxial fixation with a titanium multistranded cable, who developed fracture of the cable and migration of the cable into the spinal canal. Results: The patient was revised with removal of the broken cable, repair of the pseudarthrosis and fixation with atlantoaxial screws. Conclusion: Interlaminar fixation with cables or wires is at risk for failure with potential migration of the wire or cable into the spinal canal. The authors found that failure of the cables or wire can be salvaged with application of transarticular screws.