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Abstract
Instrumented fusion with rods and pedicle screws is often performed for the surgical treatment of adult spinal deformity (ASD). One of the complications of such long construct fusions is that of pseudoarthrosis, which can present with implant loosening, failure, and rod breakage. However, migration and spontaneous extrusion of the rod is relatively rare and has yet to be reported in the literature. We report a gentleman with previous long construct instrumented fusion done six years ago for ASD, who presented with gluteal pain. Radiographs revealed rod breakage and caudal migration towards the left gluteal region. He subsequently reported spontaneous extrusion of the broken rod through the gluteal skin, without the need for surgical removal. This case is reported for its rarity and to raise awareness about the rare occurrence of rod migration after breakage that can lead to potential complications if left unattended.
Highlights
Adult spinal deformity (ASD) is of increasing concern as our population ages and life expectancy increases, along with improved access to healthcare resources
There have been cases of caudal rod migration to areas ranging from the gluteal region to the knee described in the literature, these cases required removal of the migrated rods surgically
We describe a case of a patient with migration of a spinal fusion rod and spontaneous extrusion, which is to our knowledge the first in the literature
Summary
Adult spinal deformity (ASD) is of increasing concern as our population ages and life expectancy increases, along with improved access to healthcare resources. At the repeat follow-up, the patient reported that there was the formation of a sinus from the implant prominence, which led to spontaneous extrusion of the rod from his gluteal region while he was sitting on the toilet. This occurred just prior to his CT scan, which resulted in the resolution of his implant prominence-related symptoms. Repeat lumbar radiographs confirmed broken rods bilaterally, with the absence of the broken and migrated rod on the left side (Figure 4A,B) As he had resolution of his symptoms, and CT scan demonstrated good fusion across the other instrumented levels, the L5/S1 pseudoarthrosis was managed non-operatively
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