Research Fellow Washington University School of Medicine Rockaway, New Jersey, United States
Introduction: Anterior cervical discectomy and fusion (ACDF) is commonly performed to correct symptomatic cervical degenerative spine disease. Patients undergoing ACDF surgery may have further intervertebral disc degeneration, dysphagia, soft-tissue swelling, and dural penetration. However, hardware failure, in the form of screw loosening and migration or rod breakage, can also occur. Migration of augmented and nonaugmented screws is rare, but can lead to penetration through local structures, like the esophagus, producing regional complaints of dysphagia/odynophagia or a foreign body sensation. These symptoms may forewarn of a potentially fatal esophageal perforation. Herein, we present a case where we removed a migrated screw lodged in the esophagus on request from a patient with a failed anterior cervical fusion without regional complaints of esophageal involvement.
Methods: The migrated screw was discovered by CT myelogram. Routine preoperative investigations and assessment of bone density were performed and revealed that the patient had a normal bone density. The previous ACDF incision was reopened and exposure was gained under the guidance of a head and neck surgeon. Care was taken to preserve esophageal integrity. Longus coli were mobilized off the spine bilaterally with electrocautery. Following exposure, the locking mechanism and screws were removed from C4-7 bilaterally, and the plate was removed. A complex lateral exposure was then performed lateral to the C4 and C5 transverse processes to obtain the detached screw. The right screw was found lodged in the esophagus wall and excised with the use of a 15-blade. The integrity of the esophagus was maintained and checked with an endoscope. Oral hydrogen peroxide solution was then utilized which demonstrated no esophageal egress. Fluoroscopy was then performed to confirm the removal of the instrumentation.
Results: The mobile right plate screw which migrated to the contralateral side was successfully removed. The patient had an uneventful postoperative course.
Conclusion : Failure of anterior cervical fusion carries a risk of distal screw migration, which may be asymptomatic even if the screw is lodged in the esophagus. A complex lateral exposure can be utilized to retrieve the migrated screw.:
