Endoscopic Extruded Screw Removal after Anterior Cervical Disc Fusion: Technical Case Report

Lee, Wha-Joon; Sheehan, Jonas M.; Stack, Brendan C.

doi:10.1227/01.neu.0000199157.21444.bf

Cited by 13 publications

(14 citation statements)

References 5 publications

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“…Martínez-Lage et al reported that graft dislodgement occurred in 6%–10% of patients, while Lowery and McDonough showed the incidence of instrumentation failure to be as high as 35% [8]. In addition, Lee et al reported 2%–35% plate-related failure in anterior cervical fusions in their literature review [9]. The main predisposing factor to the development of screw and plate extrusion is suboptimal positioning of these screws [10].…”

Section: Discussionmentioning

confidence: 99%

“…Geyer and Foy reported a 76-year-old woman with oral extrusion of a missing locking plate 5 years after a C4-C5 decompression and fusion [4]. Lee et al demonstrated endoscopic extrusion of a screw after anterior cervical disc fusion, which caused esophageal perforation [9]. Yee and Terry reported a patient with complete screw migration that perforated the esophagus.…”

Section: Discussionmentioning

confidence: 99%

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Missing Screw as a Rare Complication of Anterior Cervical Instrumentation

Duransoy

Mete

Zengel

et al. 2013

Case Reports in Orthopedics

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Although anterior cervical arthrodesis is an effective procedure for the treatment of cervical disorders, the method has some complications. Here, we describe this rare complication of cervical instrumentation with a literature review. A 23-year-old male patient was operated for a C6-C7 dislocation. At postoperative month 10, he presented with hemoptysis and dysphagia. Cervical roentgenograms showed anterior migrations of one broken screw and a plate-locking screw at the C6 corpus. One screw was missing. We concluded that the missing screw had perforated the esophagus and had been eliminated spontaneously through the gastrointestinal tract. No screw should migrate. Even loose screws should be noted in follow-up X-ray studies. If such findings are detected, a second operation for revision should be considered as soon as possible to prevent potentially fatal complications.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Missing Screw as a Rare Complication of Anterior Cervical Instrumentation

Duransoy

Mete

Zengel

et al. 2013

Case Reports in Orthopedics

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“…Early mobilization is directly related to a deficient fixation technique or other complications, such as hematomas, whereas late migration is frequently related to erroneous placement during surgery …”

Section: Discussionmentioning

confidence: 99%

“…Anterior cervical fixation through different devices has been used for multiple pathologies, such as traumatism, compressive myelopathy, or spinal infections since 1967. [1][2][3][4][5][6][7][8][9] It is a broadly developed technique in neurosurgery with a reported complication rate of 5%-35%. 1 Clinical evolution is usually satisfactory and well tolerated, although serious complications can occur, such as mediastinitis, severe hemorrhage, or epidural abscess.…”

Section: Introductionmentioning

confidence: 99%

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Pharyngeal perforation after anterior cervical spine surgery treated by transoral endoscopic surgery

et al. 2017

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Transoral Removal of an Extruded Odontoid Screw Causing Dysphagia and Dysphonia

2020

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A 77‐year‐old male underwent open reduction and internal fixation with placement of odontoid screws after sustaining C1 arch and odontoid fractures in a fall 14 months prior to presentation to the laryngology clinic for combined surgery with orthopedics. Serial imaging after the initial surgery demonstrated loosening of a screw and its entry into the pharyngeal lumen. The patient reported odynophagia, dysphagia, and dysphonia. He reported taking small bites and using liquid assist, vocal fatigue, and difficulty with pitch control. A surgical screw entering the pharynx just inferior to the level of the tip of the epiglottis was seen on flexible laryngoscopy. On phonation, the screw made intermittent contact with the right arytenoid resulting in restriction of full abduction of the right vocal fold. On flexible endoscopic evaluation of swallowing, there was pharyngeal and vallecular residue, and residue around the screw itself. The patient was taken to the operating room with orthopedic surgery, the screw was visualized with a combination of mouth gag and endoscopes. It was gently rocked with an orthopedic screw grabber and tapped toward the caudal pharynx. After successful removal, the mucosal defect was sutured. The patient reported improvement in swallowing postoperatively. Dysphagia is a described sequela of cervical spine surgery. We describe the presentation and treatment of a patient with a history of cervical spine surgery and subsequent exposure of an orthopedic screw in the pharynx. Laryngoscope, 131:1078–1080, 2021

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Endoscopic Extruded Screw Removal after Anterior Cervical Disc Fusion: Technical Case Report

Abstract: A transpharyngeal endoscopic approach to remove loose anterior cervical hardware is feasible and warrants further evaluation.

Cited by 13 publications

References 5 publications

Missing Screw as a Rare Complication of Anterior Cervical Instrumentation

Missing Screw as a Rare Complication of Anterior Cervical Instrumentation

Pharyngeal perforation after anterior cervical spine surgery treated by transoral endoscopic surgery

Transoral Removal of an Extruded Odontoid Screw Causing Dysphagia and Dysphonia

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