• Hirohito Hirata, Tadatsugu Morimoto, Masatsugu Tsukamoto, Takaomi Kobayashi, Tomohito Yoshihara, Yu Toda, and Masaaki Mawatari.
• Department of Orthopaedic Surgery, Faculty of Medicine, Saga University, Nabeshima, Saga, Japan.
• Medicine (Baltimore). 2024 Feb 16; 103 (7): e37143e37143.

RationaleComplications of rod migration into the occipital bone after upper cervical fusion are very rare. No other cases have been reported, especially when associated with destructive spondyloarthropathy (DSA). The purpose of this case report is to remind clinicians of the risk of rod migration in cervical spine surgery in patients with DSA and to provide information on its causes, countermeasures, and treatment.Patient ConcernThis case report presents the clinical course of a 61-year-old female patient with chronic kidney disease that required hemodialysis.Diagnosis, Intervention, OutcomesThe patient was diagnosed DSA involving the cervical spine. Initial treatment involved a halo vest, followed by anterior cervical corpectomy and fusion spanning from C5 to Th1. However, subsequent complications, including C5 fractures, kyphotic cervical alignment, and rod migration into the occipital bone, lead to multistage surgical interventions. This case highlights the challenges in managing DSA, the significance of optimal fixation strategies, and the importance of accounting for potential alignment changes.ConclusionThe effective management of occipital bone erosion after posterior cervical spine surgery for destructive spondyloarthropathy necessitates meticulous fixation planning, proactive rod length adjustment, preoperative assessment of the occipital position, and consideration of the compensatory upper cervical range of motion to prevent migration-related issues.Copyright © 2024 the Author(s). Published by Wolters Kluwer Health, Inc.

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