An Unusual Instrumentation-Related S1 Radiculopathy in a Patient Treated for a Primary Vertebral (L3) Lymphoma

Abstract

Paravertebral titanium rod migration represents an unusual and potentially fatal complication of vertebral stabilization surgical procedures. This condition, which requires a prompt and rapid diagnosis, is often mistaken for other more common diseases, or scotomized. We present a case of a 69 years old female affected by a non-Hodgkin lymphoma with evidence of migration of both rods five years after the posterior stabilization procedure for a pathological L3 fracture. Unusual clinical onset was represented by a left S1 radiculopathy without other symptoms. For several months, the symptoms were attributed to a possible radicular infiltration by the lymphoma. We conclude that paravertebral rod migration could happen not only within the spinal canal, but could also rarely damage blood vessels or parenchymal organs. This is generally a long-term complication, probably due to an insufficient fixation. Strict long-term follow-up monitoring is mandatory since this unusual complication can mimic other more common pathological conditions.

Migration of Rod into Retroperitoneal Region: A Case Report and Review of the Literature

“…Distal rod migration to the posterior cranial fossa, lung pleura, and leg has also been notified in the literature 3 , 4 , 6 , 11) . Sometimes, patients did not have any symptoms and they were diagnosed during their routine clinical controls or they presented with symptoms related to instability due to ineffective arthrodesis like in our case 3 , 8 , 11) . Table 1 presents in detail, distally migrated rod cases with clinical presentations, treatment approaches and instrumentation types used in their previous surgery.…”

“…Rod fracture incidence is between 2 and 11% 4) . Its migration out of spinal column is extremely uncommon 4 , 8) . When this occurs, it may result in catastrophic outcomes such as visceral and vascular injury 4) .…”

“…Spinal stabilization with instrumentation is a widely used method for spinal traumas, degenerative spinal disease, and sometimes at congenital spinal malformations. Complications may occur perioperatively or after surgery, such as soft tissue injuries, neurological deficits, acute respiratory failure, hematomas, infections, failure of fusion, breakage or dislodgement of screw or rod 1 , 4 , 8 , 10) . Even rod migration through the spinal column may occur 8) .…”

“…Complications may occur perioperatively or after surgery, such as soft tissue injuries, neurological deficits, acute respiratory failure, hematomas, infections, failure of fusion, breakage or dislodgement of screw or rod 1 , 4 , 8 , 10) . Even rod migration through the spinal column may occur 8) . We are describing a case of migrated rod to the retroperitoneal area proven with radiological imaging modalities.…”

“…We are describing a case of migrated rod to the retroperitoneal area proven with radiological imaging modalities. In the literature, a few cases of distal migration of rod have been reported ( Table 1 ) 1 , 2 , 3 , 4 , 5 , 6 , 7 , 8 , 9 , 11 , 12) .…”