Fracture of Fused Vertebrae More Than 20 Years After Anterior Cervical Fusion: A Case Report.

Anterior cervical fusion surgery is widely performed for cervical spine disorders. While generally effective, late complications such as vertebral fractures in fused segments are rare but clinically significant, especially in elderly patients with bone fragility. We report here the case of an 84-year-old woman who developed a flexion deformity fracture at a fused cervical segment more than 20 years after anterior cervical corpectomy and fusion with autologous iliac bone grafting and C4 laminoplasty. She presented with neck pain and radicular symptoms in her left arm after a fall. Initial conservative treatment with a cervical collar was attempted; however, the neurological symptoms worsened due to instability at the fracture site. Therefore, we proceeded to surgical management, which included halo traction, anterior reconstruction using a titanium mesh cage with autologous bone grafting, and posterior fixation with pedicle screws. The symptoms resolved after surgery, and bone fusion was confirmed. This case highlights the potential for delayed fracture at a fused cervical segment in an elderly patient. Comprehensive anterior and posterior reconstruction can effectively restore stability. Long-term monitoring is essential after anterior cervical fusion surgery, particularly in patients with risk factors for bone fragility.