Rationale: The zero-profile, standalone device (Zero-P, Synthes GmbH, Switzerland) has been reported to be an effective and safe treatment method with similar clinical outcomes compared with plate. Instrumental complications concerning Zero-P have been little reported. Considering the rarity, we present this amazing case to share with our spinal surgeons and instrument specialists.
Patient Concerns: A 46-year-old man patient presented to our hospital with neck and shoulders pain for 23 years, numbness and weak-ness of right hand for 6 months.
Diagnoses: Hypoesthesia in the right C6 and C7 roots distribution, myodynamia weakness of the right little finger was detected from physical examination. Two-level anterior cervical decompression and fusion (ACDF) using the Zero-P was performed via a classic right Smith-Robinson approach after induction of general anesthesia. Three months postoperative x-rays showed a good position of the implant. Six months postoperative x-rays showed a locking screw at the segment C6/7 pulled out. The patient was diagnosed as screw pullout after ACDF.
Interventions: The patient was treated conservatively with regular follow-up as he was asymptomatic and no evidence of esophageal perforation was detected.
Outcomes: The patient was followed again and 24 months postoperative x-rays also showed the pulled-out locking screw had re-screwed spontaneously. The patient was noticed that a revision surgery was needed if symptoms occur. At present bony union is not reached but he is still asymptomatic.
Lessons: Pulled-out screws re-screwed spontaneously are rare but it does occur. Insertion angle may affect the stability of the Zero-P device, and the repeated micro-motion may be the critical reason of the screw pull-out and re-screwing. The management of screws pull-out after ACDF remains individualized and a revision surgery is not necessary for every patient. Conservative treatment such as orthosis and regular follow-ups may be suitable for some asymptomatic patients.
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| http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5419933 | PMC |
| http://dx.doi.org/10.1097/MD.0000000000006827 | DOI Listing |
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