title: Extrusion of a screw into the gastrointestinal tract after anterior cervical spine plating.
abstract: In this case report of a screw extrusion into the gastrointestinal tract of a patient 16 months after anterior cervical discectomy and fusion (ACDF), the authors describe a rare but potentially lethal complication and review the literature on this topic. A 70-year-old white man with a surgical history of ACDF at C3-4 underwent an ACDF at C5-6 with autologous bone graft and a dynamic plate using locking, expanding screws. Sixteen months after the operation the patient presented with severe dysphagia. Radiographic findings indicating pulling out of the implanted plate and screws prompted a surgical removal of the instrumentation. One of the screws was not found during the operation and was visualized after surgery by abdominal radiography in the right lower abdominal quadrant. A subsequent Gastrografin swallowing test revealed an esophageal tear. The screw was removed endoscopically and the patient received antibiotics and had no oral intake for 4 days. He was discharged without symptoms on a soft mechanical diet; at 24 weeks, follow-up revealed no changes or symptoms. Screw extrusion into the gastrointestinal tract following ACDF is a rare but potentially lethal complication. The use of locking, expanding screws does not extinguish the risk of this complication, particularly in cases of suboptimal initial placement of the anterior instrumentation. Close follow-up is of paramount importance in detecting any pull-out of the implanted plate. Any signs of postoperative dysphagia or throat soreness should prompt immediate evaluation of the patient and, if indicated, surgical removal of the failed instrumentation.
authors.affiliation: Department of Neurosurger, The Medical Center of Central Georgia, Mercer University School of Medicine, Macon, GA 31201, USA. knfountasmd@excite.com
authors.forename: Kostas N
authors.initials: KN
authors.lastname: Fountas
authors.forename: Eftychia Z
authors.initials: EZ
authors.lastname: Kapsalaki
authors.forename: Theofilos
authors.initials: T
authors.lastname: Machinis
authors.forename: Joe Sam
authors.initials: JS
authors.lastname: Robinson
mesh_terms: D000368:Aged; D001860:Bone Plates / Q000009:adverse effects*; D001863:Bone Screws / Q000009:adverse effects*; D002574:Cervical Vertebrae / Q000601:surgery*; D004939:Esophageal Perforation / Q000175:diagnosis / Q000209:etiology* / Q000628:therapy; D005548:Foreign-Body Migration / Q000175:diagnosis / Q000209:etiology* / Q000628:therapy; D041981:Gastrointestinal Tract / Q000000981:diagnostic imaging*; D006801:Humans; D008297:Male; D011475:Prosthesis Failure; D011859:Radiography; D013123:Spinal Fusion / Q000009:adverse effects*