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

Gazzeri, Roberto; Tamorri, M; Faiola, Andrea; Gazzeri, G

doi:10.1097/brs.0b013e31816b8831

Cited by 60 publications

(45 citation statements)

References 15 publications

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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%

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

Τάσιου¹,

Giannis²,

Brotis³

et al. 2017

J. Spine Surg.

107

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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Section: Implant Failurementioning

confidence: 99%

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.

107

113

View full text Add to dashboard Cite

show abstract

“…Examples of such implant-associated complications include screw loosening, screw breakage, and plate breakage, screw pullout with or without migration into gastrointestinal tract (8, 13,16,24,27,37). Rarely, erosion of anterior cervical plate into pharynx with pharyngotracheal fistula (22) or pharyngocutaneous fistula may occur (31).…”

Section: A B Azab W Et Al: Anterior Cervical Diskectomy With Zero-prmentioning

confidence: 99%

Outcome evaluation of a zero-profile implant for anterior cervical diskectomy with fusion

Azab¹,

Abdel-Razek²,

Ali³

et al. 2012

Turkish Neurosurgery

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AIm: Supplementing anterior cervical diskectomy and fusion (ACDF) with plates enhances stabilization, increases fusion and reduces failure rates. Zero-P implant for stand-alone anterior interbody fusion procedures of the cervical spine was recently developed to avoid complications associated with anterior cervical plates. We evaluate the outcome of its use in our patients undergoing ACDF. mATeRIAL and meTHods: 84 patients were selected to undergo ACDF with Zero-P implant of whom 75 (52 male and 23 female) were followed up for 12 to 16 months (mean 14.2 months) with a total of 94 operated levels (54 single, 21 double level). Patients underwent pre-and postoperative clinical evaluation with full neurological examination, visual analogue scale (VAS), Neck Pain and Disability Scale (NPAD) and Bazaz-Yoo dysphagia index for postoperative dysphagia. Postoperative plain X-ray evaluation of fusion and implant-associated complications was done.ResuLTs: All patients had significant reduction in arm and neck pain and NPAD maintained over 12 months, no implant-associated complications during follow-up, and radiological fusion by 3 months. None had dysphagia after 3 months postoperatively. CoNCLusIoN:The Zero-P implant is a valid alternative to anterior cervical plating after ACDF with a very low incidence of postoperative dysphagia and no implant-related complications.KeywoRds: Anterior, Cervical, Diskectomy, Zero-profile, Plate, Dysphagia ÖZ AmAÇ: Anterior servikal diskektomi ve füzyonu (ACDF) plakalarla desteklemek stabilizasyonu güçlendirir, füzyonu arttırır ve başarısızlık oranını azaltır. Anterior servikal plakalarla ilişkili komplikasyonlardan kaçınmak üzere yakın zamanda servikal omurganın tek başına anterior interbody füzyon işlemleri için Zero-P implantı geliştirilmiştir. ACDF yapılan hastalarımızda bu implantın kullanılmasının sonuçlarını değerlendirdik. BuLGuLAR: Tüm hastalarda 12 ay boyunca devam edecek şekilde kol ve boyun ağrısı ve NPAD bakımından önemli azalma oldu, takip boyunca implantla ilişkili komplikasyon görülmedi ve 3 ay içinde radyolojik füzyon gerçekleşti. Ameliyattan 3 ay sonra hiçbirinde disfaji yoktu.soNuÇ: Zero-P implantı ACDF sonrasında servikal plakalama için geçerli bir alternatiftir ve postoperatif disfaji insidansı çok düşük olup implantla ilişkili bir komplikasyon görülmemiştir.

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“…Additionally, although hardware failure of absorbable plates appears to occur early after the procedure or intraoperatively, metallic devices can cause complications at any time after implantation. 11,14,19,20 Lyons et al 15 stated that the sheep cervical spine is subject to different angular forces than the human spine because of obvious differences between quadrupeds and bipeds. Unlike sheep, humans often wear a cervical collar postoperatively to further immobilize the spine during healing and fusion.…”

mentioning

confidence: 99%

“…11,19 Also, the artifacts generated by the metallic alloy can obscure the interpretation of postoperative images. 2 A biodegradable ACP (bACP) was introduced to overcome these limitations.…”

mentioning

confidence: 99%

Outcomes observed during a 1-year clinical and radiographic follow-up of patients treated for 1- or 2-level cervical degenerative disease using a biodegradable anterior cervical plate

Chen

Yang

et al. 2016

SPI

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OBJECTIVE The purpose of this study was to present an initial surgical experience in the management of 1- or 2-level degenerative disc disease of the cervical spine using biodegradable anterior cervical plates (bACPs) in anterior cervical discectomy and fusion (ACDF). The authors also aimed to provide insight into this critical and controversial clinical issue by clarifying outcomes for patients receiving bACPs and by comparing their outcomes with those achieved using a traditional metallic anterior cervical plate (mACP) implant. METHODS A retrospective review was conducted for 2 series of patients who had undergone ACDF using either bACP (31 patients, 38 segments) or mACP (47 patients, 57 segments) instrumentation. The patients were followed up for a mean 13.5 ± 0.9 months (range 12–18 months) in the bACP group and 14.8 ± 1.5 months (range 14–22 months) in the mACP group. Clinical outcomes were determined according to scores on the visual analog scale (VAS), the modified Japanese Orthopaedic Association (mJOA) scoring system, and Odom's criteria. Radiological images were used to assess fusion rates, intervertebral height, Cobb's angle, and the width of prevertebral soft tissue. RESULTS Both VAS and mJOA scores were significantly improved at each follow-up in both groups. Excellent or good results according to Odom's criteria were achieved in 93.5% (29/31) of patients in the bACP group and 93.6% (44/47) of patients in the mACP group. At 6 months postoperatively, the fusion rate was 94.7% (36/38) in the bACP group and 96.5% (55/57) in the mACP group, but subsidence of the intervertebral space at the surgical level was more evident in the bACP group. Angulation, as measured by Cobb's angle, demonstrated obvious healing in both groups, while better maintenance was observed in the mACP group. The local inflammatory reaction was uneventful during follow-up. Dysphonia and dysphagia were observed in both groups during the follow-up. CONCLUSIONS The relatively comparable early clinical and radiographic outcomes and the overall acceptable complication rates for bACP and mACP use suggest that bACPs could be used as alternative instruments in ACDF. Mild graft resorption was noted without evidence of symptoms. However, the prospective efficacy of biodegradable instrumentation can only be elucidated with longer-term observation.

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

Abstract: In this case, the delayed esophageal perforation occurred 11 years after initial surgery: the rapid progression of the screw extrusion after initial pull-out (6 days) was documented by several radiographs and spontaneous closure of the fistula was achieved.

Cited by 60 publications

References 15 publications

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

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

Outcome evaluation of a zero-profile implant for anterior cervical diskectomy with fusion

Outcomes observed during a 1-year clinical and radiographic follow-up of patients treated for 1- or 2-level cervical degenerative disease using a biodegradable anterior cervical plate

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