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Background: Dysphagia is a common complication immediately following anterior cervical spine surgery. However, its onset more than 1-year postoperatively is rare. Case Description: A 45-year-old male initially underwent a C3-4 and C5-6 anterior cervical discectomy and fusion (ACDF). At age 49, 4 years later, he presented with worsening dysphagia accompanied by neck and right upper extremity pain. Radiographs demonstrated an extruded left C3 screw, which had migrated into the prevertebral soft tissues at the C4-C5 level; there was also loosening of the right C3 screw. The subsequent barium swallow study revealed that the screw was embedded in the pharyngeal wall. The patient required a two-stage operation; first, to remove the anterior instrumentation, and second, to perform a posterior instrumented C2-T2 fusion. Conclusion: A barium swallow study and other dynamic imaging are a valuable component of the diagnostic workup and therapeutic intervention to evaluate the delayed onset dysphagia following an ACDF.

Variations of the pectoralis major muscle are commonly seen. However, during the routine dissection of an adult male cadaver, an apparently uncommon muscular variant was identified. In this cadaver, the sternal heads of the left and right pectoralis muscles crossed the midline and interdigitated with one another. In addition, the clavicular heads of both pectoralis major muscles were separated from the remaining parts of the muscles. Such anatomical variants such be kept in mind by clinicians and surgeons during patient evaluation and treatment.

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This report presents an unusual case of instrumentation failure after posterior fixation of a C2 fracture and reviews currently available treatment alternatives. The patient, a 53-year-old female, initially presented to the emergency department at an outside facility with acute alcohol intoxication and acute neck pain following a fall from a ladder. CT demonstrated bilateral C2 pars fractures and unstable posteroinferior displacement of the posterior elements. She underwent an emergent C2 open-reduction internal fixation (ORIF) at the outside facility with 3.5 mm polyaxial synapse pedicle screws (DePuy Synthes, Switzerland). There were no known complications and the patient was discharged. Two years after the index operation, cervical CT scan at a different facility revealed that although the fracture was fully healed, bilateral tulip caps had detached from the pedicle screw heads at C2. All implants were removed without postoperative complications. Industry review of alternate lag screws approved for the cervical spine demonstrated that there is not currently an ideal implant for fixation of C2 fractures without fusion. Cannulated trauma screws, which are low profile and would have avoided the instrumentation failure seen here, are not currently FDA approved for the cervical spine.