Extrusion of a Screw Into the Gastrointestinal Tract After Anterior Cervical Spine Plating

Fountas, Kostas N.; Kapsalaki, Eftychia Z.; Machinis, Theofilos; Robinson, Joe Sam

doi:10.1097/01.bsd.0000164164.11277.49

Cited by 68 publications

(38 citation statements)

References 21 publications

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“…Indication for cervical spine surgery was either trauma or degenerative disease; however, there seems to be more trauma patients. Some authors have reported that many of their patients who suffered from esophageal complications had experienced two or more cervical spine operations [15][16][17]; however, among the eight pharyngoesophageal diverticulum patients, only two of them had a second cervical operation. Graft or implant dislodgment also does not seem necessary for pharyngoesophageal diverticulum, as four of the patients just had normal implant position.…”

Section: Discussionmentioning

confidence: 99%

Pharyngoesophageal diverticulum: a delayed complication of anterior cervical spine surgery

et al. 2010

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Pharyngoesophageal diverticulum after anterior cervical spine surgery is a rarely reported but potentially life-threatening complication. A case report of pharyngoesophageal diverticulum 7 years after anterior cervical spine surgery is presented. The patient suffered from dysphagia, odynophagia, recurrent fever, weight loss, and also an impressive bulging in the neck with swallowing. After careful examination and preparation, he underwent revision surgery via an open procedure, had the implants removed, pouch excised, and esophagus reconstructed reinforced by a sternohyoid muscle flap as well as an omohyoid muscle flap. The post-operative period was uneventful, and he experienced a satisfactory recovery. At last follow up, 2.5 years post surgery, the patient remained symptom free. Upon review of the literature, only six such previous reports with seven cases were found. Diagnostic tools, possible mechanism, correlative factors and treatment are discussed. This patient was fortunate that although his symptoms developed long after the initial anterior cervical operation and the pouch grew impressively large almost perforating, he still recovered well. It again proves the necessity of long-term X-ray follow up, and also reminds the surgeons to be alert of the possibility of esophageal injury even when the esophageal symptoms are mild and occur long after the initial operation.

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Section: Discussionmentioning

confidence: 99%

Pharyngoesophageal diverticulum: a delayed complication of anterior cervical spine surgery

et al. 2010

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“…27,30 Application of a cervical plate has gained acceptance as a means of increasing fusion rates and preventing graft dislodgement, but it can be expensive and has been associated with complications such as dysphagia, infection, and instrumentation failure. 4,13,23,24 Instrumented fusion is also associated with a significantly higher amount of intraoperative blood loss when compared with procedures in which plate fixation is not used. 31 The effectiveness of plate fixation in single-level ACDF is controversial, and there are significant differences in fusion rates among published studies.…”

Section: Discussionmentioning

confidence: 99%

Radiographic and clinical outcomes following single-level anterior cervical discectomy and allograft fusion without plate placement or cervical collar

Jagannathan¹,

Shaffrey²,

Oskouian³

et al. 2008

SPI

130

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Object Although the clinical outcomes following anterior cervical discectomy and fusion (ACDF) surgery are generally good, 2 major complications are graft migration and nonunion. These complications have led some to advocate rigid internal fixation and/or cervical immobilization postoperatively. This paper examines a single-surgeon experience with single-level ACDF without use of plates or hard collars in patients with degenerative spondylosis in whom allograft was used as the fusion material. Methods The authors conducted a retrospective review of a prospective database of (Cloward-type) ACDF operations performed by the senior author (J.A.J.) between July 1996 and June 2005. Radiographic follow-up included static and flexion/extension radiographs obtained to assess fusion, focal and segmental kyphosis, and change in disc space height. At most recent follow-up, the patients' condition was evaluated by an independent physician examiner. The Odom criteria and Neck Disability Index (NDI) were used to assess outcome. Results One hundred seventy patients underwent single-level ACDF for degenerative pathology during the study period. Their most common presenting symptoms were pain, weakness, and radiculopathy; 88% of patients noted ≥ 2 neurological complaints. The mean hospital stay was 1.76 days (range 0–36 days), and 3 patients (2%) had major immediate postoperative complications requiring reoperation. The mean duration of follow-up was 22 months (range 12–124 months). Radiographic evidence of fusion was present in 160 patients (94%). Seven patients (4%) showed radiographic evidence of pseudarthrosis, and graft migration was seen in 3 patients (2%). All patients had increases in focal kyphosis at the operated level on postoperative radiographs (mean −7.4°), although segmental alignment was preserved in 133 patients (78%). Mean change in disc space height was 36.5% (range 28–53%). At most recent clinical follow-up, 122 patients (72%) had no complaints referable to cervical disease and were able to carry out their activities of daily living without impairment. The mean postoperative NDI score was 3.2 (median 3, range 0–31). Conclusions Single-level ACDF without intraoperative plate placement or the use of a postoperative collar is an effective treatment for cervical spondylosis. Although there is evidence of focal kyphosis and loss of disc space height, radiographic evidence of fusion is comparable to that attained with plate fixation, and the rate of clinical improvement is high.

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“…Cloward (113) provided one of the first reports on graft migration. Since then, mechanical failure and/or screw migration have been reported (41,42,97,(114)(115)(116). Initial malposition or suboptimal position is the most common reason for mechanical fatigue, and eventual failure of the implant.…”

Section: Implant Failurementioning

confidence: 99%

“…Additionally, neurovascular or adjacent organ injuries have been reported (17,20,27,(29)(30)(31)(32)(33)(34)(35)(36)(37)(38)(39). Implant related complications have also been reported in the literature (20,27,(40)(41)(42)(43)(44). The list also includes functional complications such as dysphagia, dysphonia, and difficulty in swallowing (7,(45)(46)(47)(48)(49)(50)(51).…”

Section: Introductionmentioning

confidence: 99%

Anterior cervical spine surgery-associated complications in a retrospective case-control study

Τάσιου¹,

Giannis²,

Brotis³

et al. 2017

J. Spine Surg.

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120

113

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Anterior cervical spine procedures have been associated with satisfactory outcomes. However, the occurrence of troublesome complications, although uncommon, needs to be taken into consideration.The purpose of our study was to assess the actual incidence of anterior cervical spine procedure-associated complications and identify any predisposing factors. A total of 114 patients undergoing anterior cervical procedures over a 6-year period were included in our retrospective, case-control study. The diagnosis was cervical radiculopathy, and/or myelopathy due to degenerative disc disease, cervical spondylosis, or traumatic cervical spine injury. All our participants underwent surgical treatment, and complications were recorded.The most commonly performed procedure (79%) was anterior cervical discectomy and fusion (ACDF).Fourteen patients (12.3%) underwent anterior cervical corpectomy and interbody fusion, seven (6.1%) ACDF with plating, two (1.7%) odontoid screw fixation, and one anterior removal of osteophytes for severe Forestier's disease. Mean follow-up time was 42.5 months (range, 6-78 months). The overall complication rate was 13.2%. Specifically, we encountered adjacent intervertebral disc degeneration in 2.7% of our cases, dysphagia in 1.7%, postoperative soft tissue swelling and hematoma in 1.7%, and dural penetration in 1.7%. Additionally, esophageal perforation was observed in 0.9%, aggravation of preexisting myelopathy in 0.9%, symptomatic recurrent laryngeal nerve palsy in 0.9%, mechanical failure in 0.9%, and superficial wound infection in 0.9%. In the vast majority anterior cervical spine surgery-associated complications are minor, requiring no further intervention. Awareness, early recognition, and appropriate management, are of paramount importance for improving the patients' overall functional outcome.

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Extrusion of a Screw Into the Gastrointestinal Tract After Anterior Cervical Spine Plating

Cited by 68 publications

References 21 publications

Pharyngoesophageal diverticulum: a delayed complication of anterior cervical spine surgery

Pharyngoesophageal diverticulum: a delayed complication of anterior cervical spine surgery

Radiographic and clinical outcomes following single-level anterior cervical discectomy and allograft fusion without plate placement or cervical collar

Anterior cervical spine surgery-associated complications in a retrospective case-control study

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