Delayed anterior cervical plate dislodgement with pharyngeal wall perforation and oral extrusion of cervical plate screw after 8 years: A very rare complication

Abstract

We report a patient with congenital anomaly of cervical spine, who presented with clinical features suggestive of cervical compressive spondylotic myelopathy. He underwent C3 median corpectomy, graft placement, and stabilization from C2 to C4 vertebral bodies. Postoperative period was uneventful and he improved in his symptoms. Eight years later, he presented with a difficulty in swallowing and occasional regurgitation of feeds of 2 months duration and oral extrusion of screw while having food. On oral examination, there was a defect in the posterior pharyngeal wall through which the upper end of plate with intact self-locking screw and socket of missed fixation screw was seen. This was confirmed on X-ray cervical spine. He underwent removal of the plate system and was fed through nasogastric tube and managed with appropriate antibiotics. This case is presented to report a very rare complication of anterior cervical plate fixation in the form of very late-onset dislodgement, migration of anterior cervical plate, and oral extrusion of screw through perforated posterior pharyngeal wall.

Pharyngeal perforation after anterior cervical spine surgery treated by transoral endoscopic surgery

“…Delayed extrusions similar to our case have been described at 11 years in the gastrointestinal tract, Yamgoue Tchameni et al a pharyngoesophageal exposition 3 years after surgery, and Kapu et al after 8 years. In a review study, Newhouse et al found only 10 cases of delayed extrusion ranging from months to years.…”

Biomechanical Comparison of Integrated Fixation Cage Versus Anterior Cervical Plate and Cage in Anterior Cervical Corpectomy and Fusion (ACCF): A Finite Element Analysis

“…Secondly, ACP-induced compression to adjacent tissues may lead to esophageal and pharyngeal injury, dysphagia, and adjacent-level degeneration [9–12]. Furthermore, ACP or screw failure severely injures peripheral tissue, leading to serious consequences, even death [13,14]. These problems of ACP need to be resolved.…”

Late-Onset Dysphagia From Hardware Migration After Anterior Cervical Discectomy and Fusion: An Unusual Cause and Review of Literature

“…The clinical management of hardware migration is variable based on problem severity, patient's general condition, and the presence/risks of complications. 23 A surgical revision is not necessary for every patient. Conservative management of hardware migration is advised with no dislodged plate, if the patient is asymptomatic with no evidence of oesophageal perforation.…”