Esophageal perforation from anterior cervical screw migration

Sahjpaul, Ramesh

doi:10.1016/j.surneu.2006.09.032

Cited by 74 publications

(49 citation statements)

References 11 publications

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“…The former include a higher fusion rate, particularly in multilevel cases, a better alignment of the cervical spine, with restoration or maintenance of lordosis, and the prevention of interbody graft/cage dislocation or subsidence [28]. Among the latter, dysphagia and tracheoesophageal lesions are the most frequently reported [9,31]. Yet, asymmetry of the anterior surface of the cervical spine, related to the presence of osteophytes in patients with spondylosis or to minor spondylolisthesis secondary to degenerative changes or trauma, is another condition requiring careful consideration before implanting a plate (Figs.…”

Section: Discussionmentioning

confidence: 99%

“…Anterior cervical plates may increase interbody fusion rates [6,10,16,35] and stability [16], maintain or improve cervical sagittal alignment [18,28] and prevent interbody graft dislocation or subsidence [28], particularly in multiple-level ACDFs; however, anterior plating may also be associated with potential disadvantages and complications [17], including increased dysphagia rates [5,29,37,41], tracheoesophageal lesions [31], plate malposition and accelerated adjacent disc degeneration [31], even when low-profile plates are used. Furthermore, in patients harboring spondylotic alterations, such as anterior endplates osteophytes or extensive anterior bony ossification bridging several vertebral bodies, a careful surgical preparation of the anterior surface of the cervical spine, i.e., adequate ''flattening'' of the bony anterior cervical surface, is required to position the plate.…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Zero-P: a new zero-profile cage-plate device for single and multilevel ACDF. A single Institution series with four years maximum follow-up and review of the literature on zero-profile devices

et al. 2013

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Purpose To analyze the prospectively collected data in a series of patients treated with single-or multilevel ACDF with a stand-alone, zero-profile device, focusing on clinicoradiological outcome, complications and technical hints, and to review the literature on such new devices. Methods Eighty-five patients harboring symptomatic DDD underwent ACDF with the Zero-P cage-plate: 29 at 1-level and 56 at 2-4 levels (total 162 devices). In the multilevel group, 9 patients received a combination of Zero-P and stand-alone cages (hybrid implants). This study focuses on 32 patients with follow-up ranging from 20 to 48 months. NDI, SF-36 and arm pain VAS scores were registered preoperatively and at follow-up visits. Dysphagia was assessed using the Bazaz score. Imaging included X-rays, CT and MRI, also to assess the presence of vertebral body fractures in multilevel cases. Paired Student t test was used for statistical analysis. Results SF-36 and NDI showed a statistically significant improvement (p \ 0.01) and mean arm pain VAS score decreased from 79 to 41. X-rays and CT demonstrated, respectively, a 94.5 % and a 92 % fusion rate. Three patients complained of moderate and two of mild transient dysphagia (15.5 %). No device-related complications occurred and no fractures, secondary to four screws insertion in one vertebral body (i.e., swiss cheese effect), were detected in multilevel cases. In patients with extensive anterior osteophytes only a ''focal spondylectomy'' was required. Conclusion The Zero-P device is safe and efficient, even in multilevel cases. Dysphagia is minimal, extensive anterior osteophytectomy is unnecessary and technical hints may ease the surgical workflow. This is the largest series, with the longest follow-up, reported.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Zero-P: a new zero-profile cage-plate device for single and multilevel ACDF. A single Institution series with four years maximum follow-up and review of the literature on zero-profile devices

et al. 2013

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“…The most frequent hardware complication is a broken or loosened screw or plate [8], which usually can be managed conservatively. However, erosion or migration of a loosened screw or plate into the lumen of the pharynx or esophagus has also been documented in the surgical literature as a much less common but more serious complication of this procedure [9][10][11][12][13][14][15][16][17]. The temporal relationship between implantation of an anterior cervical plate and erosion of the plate into the pharynx or esophagus is quite variable.…”

Section: Discussionmentioning

confidence: 99%

“…In one series, loosened or broken plates or screws were reported in 35% of patients who underwent this procedure [8]. Because of its location in the neck, the cervical plate or screws can also erode or migrate into the adjacent pharynx or esophagus, causing pharyngeal or esophageal perforation-a complication that has been well documented in the surgical literature [9][10][11][12][13][14][15][16][17]. To our knowledge, however, this complication has not been reported previously in the radiology literature.…”

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confidence: 89%

Erosion of Anterior Cervical Plate into Pharynx with Pharyngotracheal Fistula

Kuo

Levine

2010

Dysphagia

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We report a 58-year-old woman who presented with dysphagia and recurrent episodes of coughing and choking during swallowing 10 years after anterior cervical discectomy and fusion with implantation of an anterior cervical plate. Barium esophagography revealed erosion of the cervical plate through the posterior wall of the pharyngoesophageal junction with an extraluminal collection that extended inferiorly as a track through the posterior wall of the trachea, producing a pharyngotracheal fistula. The pharyngeal perforation was repaired and the cervical hardware removed at surgery. This rare complication of anterior cervical discectomy and fusion should be recognized as a potentially serious but treatable long-term sequela of an anterior cervical plate.

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“…1,[4][5][6]8) One of the most serious complications of hardware failure is esophageal violation. 2,3,6,7) The implanted hardware should be removed after confirmation of solid bone fusion, but compliance seems to be low because of complications caused by reoperation through the anterior approach.…”

Section: Introductionmentioning

confidence: 99%

New Surgical Technique to Secure the Bone Strut During Anterior Cervical Corpectomy and Fusion: Kusabi Fixation Technique -Technical Note-

Tani

Homma

Uchikado

et al. 2010

Neurol. Med. Chir.(Tokyo)

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Fixation using an anterior cervical plate is frequently used in anterior cervical discectomy or corpectomy and fusion procedures because of the higher fusion rate than without instrumentation. The surgical outcomes with the anterior plate technique are acceptable, but various hardware-related complications have been reported. The authors describe a new surgical technique, called the kusabi fixation technique, for securing the bone strut during anterior cervical corpectomy using cylindrical cages. Following corpectomy, the trimmed bone strut was placed into the space drilled-out. Two small holes of 5-6-mm diameter and 5-mm depth were drilled out at the interface of two bones at the top and bottom of the bone strut in a diagonal orientation. Two cylindrical cages filled with autologous bone tips were tapped into the interface. Eight patients with myelopathy were treated by this method. All procedures were uneventfully performed as a single level surgery (two vertebral bodies and one disk level). Solid bone union was obtained in all patients at 6 months after the operation. Apparent alignment change in the cervical spine was observed in only one patient, who developed asymptomatic kyphosis. No instrumentation failure or significant complications related to the surgery occurred. Precise biomechanical aspects and long-term radiographic analysis compared with the plate fixation technique should be established, but this new method provides another way to secure the bone strut in anterior cervical corpectomy and fusion.

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Esophageal perforation from anterior cervical screw migration

Cited by 74 publications

References 11 publications

Zero-P: a new zero-profile cage-plate device for single and multilevel ACDF. A single Institution series with four years maximum follow-up and review of the literature on zero-profile devices

Zero-P: a new zero-profile cage-plate device for single and multilevel ACDF. A single Institution series with four years maximum follow-up and review of the literature on zero-profile devices

Erosion of Anterior Cervical Plate into Pharynx with Pharyngotracheal Fistula

New Surgical Technique to Secure the Bone Strut During Anterior Cervical Corpectomy and Fusion: Kusabi Fixation Technique -Technical Note-

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