Late prevertebral abscess following anterior cervical plating: The missing screw

Martínez‐Lage, Juan F.; Felipe-Murcia, M.; Azorin, L.

doi:10.1016/s1130-1473(07)70295-6

Cited by 13 publications

(12 citation statements)

References 13 publications

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“…17 However, anterior cervical plates and screws are associated with both immediate and delayed hardware complications such as screw or plate migration and breakage. 6,26,32,39,43 Despite improvements in anterior cervical instrumentation, such as improved screw-locking mechanisms, complications persist. 14,15,25 Moreover, anterior cervical instrumentation is believed to contribute to the chronic postoperative dysphagia that can occur after ACDF.…”

Section: Discussionmentioning

confidence: 99%

“…An anterior plate is commonly added to enhance construct stability and reduce the rate of pseudarthrosis; however, this addition may be complicated by postoperative dysphagia, softtissue injury, and hardware failure. 2,[4][5][6]19,26,32,34,39 The pathophysiological mechanism of postoperative dysphagia remains unknown, but proposed causes include soft-tissue edema, postoperative hematoma, recurrent laryngeal nerve palsy, esophageal injury, postoperative adhesions, and device migration. 15 Some studies suggest patient age, sex, body mass index (BMI), blood loss, location of surgery, and number of operated levels as possible contributing factors to dysphagia.…”

mentioning

confidence: 99%

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Anterior cervical discectomy and fusion with a zero-profile integrated plate and spacer device: a clinical and radiological study

Njoku

Alimi

Leng

et al. 2014

SPI

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Object Anterior cervical plating decreases the risk of pseudarthrosis following anterior cervical discectomy and fusion (ACDF). Dysphagia is a common complication of ACDF, with the anterior plate implicated as a potential contributor. A zero-profile, stand-alone polyetheretherketone (PEEK) interbody spacer has been postulated to minimize soft-tissue irritation and postoperative dysphagia, but studies are limited. The object of the present study was to determine the clinical and radiological outcomes for patients who underwent ACDF using a zero-profile integrated plate and spacer device, with a focus on the course of postoperative prevertebral soft-tissue thickness and the incidence of dysphagia. Methods Using a surgical database, the authors conducted a retrospective analysis of all patients who had undergone ACDF between August 2008 and October 2011. All patients received a Zero-P implant (DePuy Synthes Spine). The Neck Disability Index (NDI) and visual analog scale (VAS) scores for arm and neck pain were documented. Dysphagia was determined using the Bazaz criteria. Prevertebral soft-tissue thickness, spinal alignment, and subsidence were assessed as well. Results Twenty-two male and 19 female consecutive patients, with a mean age of 58.4 ± 14.68, underwent ACDF (66 total operated levels) in the defined study period. The mean clinical follow-up in 36 patients was 18.6 ± 9.93 months. Radiological outcome in 37 patients was assessed at a mean follow-up of 9.76 months (range 7.2–19.7 months). There were significant improvements in neck and arm VAS scores and the NDI following surgery. The neck VAS score improved from a median of 6 (range 0–10) to 0 (range 0–8; p < 0.001). The arm VAS score improved from a median of 2 (range 0–10) to 0 (range 0–7; p = 0.006). Immediate postoperative dysphagia was experienced by 58.4% of all patients. Complete resolution was demonstrated in 87.8% of affected patients at the latest follow-up. The overall median Bazaz score decreased from 1 (range 0–3) immediately postoperatively to 0 (range 0–2; p < 0.001) at the latest follow-up. Prevertebral soft-tissue thickness significantly decreased across all levels from a mean of 15.8 ± 4.38 mm to 10.1 ± 2.93 mm. Postoperative lordosis was maintained at the latest follow-up. Mean subsidence from the immediate postoperative to the latest follow-up was 4.1 ± 4.7 mm (p < 0.001). Radiographic fusion was achieved in 92.6% of implants. No correlation was found between prevertebral soft-tissue thickness and Bazaz dysphagia score. Conclusions A zero-profile integrated plate and spacer device for ACDF surgery produces clinical and radiological outcomes that are comparable to those for nonintegrated plate and spacer constructs. Chronic dysphagia rates are comparable to or better than those for previously published case series.

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Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

Anterior cervical discectomy and fusion with a zero-profile integrated plate and spacer device: a clinical and radiological study

Njoku

Alimi

Leng

et al. 2014

SPI

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“…Six years after surgery, the patient presented with dysphasia, and in the radiological examination, the screw could no longer be identified. Plate and screw systems were removed, and the patient was treated for prevertebral abscess secondary to esophagus perforation [8]. Gazzeri et al reported a case of spontaneous healing of esophagus fistule due to screw elimination through the intestinal tract one week after the patient complained of dysphasia and high fever [17].…”

Section: Discussionmentioning

confidence: 99%

“…Rarely, these materials may penetrate into esophagus and eliminate through the intestinal tract [3,[5][6][7][8]. In this study, we report a late complication of displacement and loss of an anterior cervical plate and screws in an asymptomatic patient.…”

Section: Introductionmentioning

confidence: 91%

Asymptomatic Missing Cervical Plate and Screws: A Case Report

Menekse

2014

J Med Cases

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Anterior cervical screw-plate system has become popular and safer in the substantial cervical spine in recent years. Materials and devices for anterior stabilization have improved in reliability. Nevertheless, screw-plate stabilization includes early and late complications. Our report demonstrates that cervical screws and plate may disappear asymptomatically or without any complication, and this is also the first case of asymptomatically disappearing cervical plate in the literature. We concluded that an esophageal perforation had occurred, and the plate and screws had been eliminated through the intestinal tract without any notice.

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“…glossopharyngeal nerve, hypoglossal nerve, recurrent laryngeal nerve and vagus nerve) due to surgical manipulation with prevertebral soft tissue swelling and postoperative fibrosis causes decreased pharyngeal wall movement, incomplete epiglottic deflection, impaired upper esophageal sphincter opening with adhesion formations at the vallecular and pyriform sinuses (1-3). If dyspagia is seen at the early postoperative period, fever may or may not accompany this symptom, prevertebral abscess should be considered (4). Perforation also can be ocur associated with an vertebral osteomyelitis (5).…”

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confidence: 99%