Extrusion of BOP-B graft orally following anterior cervical discectomy and fusion

Abstract

Graft extrusion following anterior cervical discectomy and fusion is a recognized complication. We report a case of oral extrusion of a synthetic graft (BOP B, Biocompatible Orthopaedic Polymer).

Anterior Cervical Screw Extrusion Leading to Acute Upper Airway Obstruction

“…Risk factors for cervical graft failure and instrumentation migration include inadequate purchase of screws, 9 malposition and poor screw purchase, 2,8,9 poor postoperative immobilization of spine, 8,12 incomplete fusion, 9 multilevel involvement, 2 and medical illnesses contributing to poor tissue healing. 12 These risk factors were derived mainly from case reports, and no randomized trials have been performed to delineate the relative contributions from the various factors sited.…”

“…There have been a number of case reports documenting migration and oral or esophageal extrusion of anterior cervical screws, grafts, and plates. [1][2][3][4][5][6][7][8][9][10][11][12][13][14] In different reports, screws were recovered in feces, embedded in the abdomen, or coughed out externally. Although potentially serious or fatal, 7 of 8 patients with oral extrusion of graft or instrumentation had benign courses and uneventful recovery.…”

“…It is unclear as to the reason why esophageal perforation secondary to anterior cervical instrumentation dislodgement usually has benign courses. [5][6][7][8][9][10][11] It has been suggested that spontaneous recovery after esophageal rupture may result from the small diameter of screws and their slow migration process, thereby enabling the healing of the tissue and repair of the defect. 10 In our case, we hypothesize that the area of esophageal erosion was largely walled off from the prevertebral/ mediastinal space as a result of postoperative scarring and the slow, progressive nature of the instrumentation extrusion.…”

Oral Extrusion of Screw after Anterior Cervical Interbody Fusion

“…The most catastrophic event was recently described by Riew et al who reported a case of plate rupture and graft migration causing airway impairment and resulting in death of the patient 16) . The extrusion of a cervical graft has been described in the literature on only a few occasions : the oral graft extrusion of an iliac crest donor, and the oral extrusion of a screw and of a synthetic graft 5,6,14,20) . Ours is an extremely rare case in which an expansion screw from a cervical spine locking plate migrated and was extruded orally.…”

Life threatening complication of biocompatible osteoconductive polymer graft after anterior cervical discectomy

“…Dysphagia is a recognized presentation. 1 To date, no life-threatening complications of graft extrusion have been reported. We present a case of acute laryngeal obstruction due to extruded graft.…”