A Rare Case of Hypopharyngeal Screw Migration after Spine Stabilization with Plating

Abstract

Anterior cervical spine fusion and stabilization with plating are well-established surgical procedures for the treatment of myelopathy, cervical spine traumas, and spinal infectious diseases. Various complications have been described in the literature, more frequently, intraoperative bleeding, peri- or postoperative hypopharyngeal, and/or esophageal ruptures with mediastinal deep infection and loosening and extrusion of the screws from the plating. Screw migration has also been observed as a complication of the procedure, either early in the postoperative period or delayed, even after many years. In some instances, the esophageal perforation can recover spontaneously with absence of complications, even if a case of plate failure and graft migration with lethal sudden airways obstruction has been reported. We describe a case of hypopharyngeal screw migration after cervical spine stabilization with plating never described before in the literature.

An unusual displacement of the cervical plate to the inner surface of the hypopharynx

“…These events can also be led by the loosening of screws or plates that can occur years after the procedure. 4 Kothari and Almouradi 7 reported a case of a 53-year-old woman with adenocarcinoma of upper gastrointestinal tract where anterior spine fusion plate had displaced into the hypopharynx region, above the esophageal sphincter. They reported the erosion of the plate owing to her carcinogenic condition and other morbidities, which was clinically corrected.…”

“…Advancements have led to the betterment in the design and techniques of these implants such as the use of meshes and cages. 4,5 These complications can present a variety of symptoms including pain in neck and arms and dysphagia, in rare cases. 6,7…”

Oral extrusion of a vertebral body replacement device after chordoma tumor growth and radiation: case report and review

“…Screw migration following anterior cervical discectomy and fusion is a very rare complication and is often related to device failure. It may provoke pharyngeal or esophageal perforation and, eventually, the inadvertent and spontaneous expulsion of the screw through the gastrointestinal tract [ 2 , 8 , 17 , 21 , 23 ]. Oral expulsion of the screw has been occasionally reported [ 5 , 7 , 9 , 20 ], as well as the exposure or extrusion of the plate going with the screw [ 6 , 16 , 26 ].…”

Pharynxpenetration einer Schraube nach ventraler HWS-Spondylodese

“…In der Regel sind Komplikationen selten. Es werden Schluckbeschwerden in Form von Fremdkörpergefühl und Halsschmerzen sowie Dislokationen von Schrauben und Platten, Liquorleckage, wiederkehrende Kehlkopfverletzungen, pharyngoesophageale Verletzungen, prävertebrale Abszesse, Obstruktion der Atemwege, Mediastinitiden und Rupturen der A. carotis beschrieben [1][2][3][4].…”