Missing Screw as a Rare Complication of Anterior Cervical Instrumentation

Abstract

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.

Chronicle of coughed up screws

“…5,6 Dislodgement of plates is seldom asymptomatic, although, there are reports of their spontaneous passage in feces, as well. 1 The slower dislodgements seldom involve septic outcome, as evident by our case. The slow migration allows sufficient time for simultaneous fibrotic healing/walling off to take place.…”

“…A similar picture is apparent when the implant erodes into pharynx/esophagus immediately following surgery. 1,4 Slower dislodgements/perforations, especially of screws, may be asymptomatic and pass off in feces, or are, very rarely, coughed up, as in our case. 1,3 Some perforations present by forming pharyngo/esophago cutaneous fistulae.…”

“…1,4 Slower dislodgements/perforations, especially of screws, may be asymptomatic and pass off in feces, or are, very rarely, coughed up, as in our case. 1,3 Some perforations present by forming pharyngo/esophago cutaneous fistulae. 5,6 Dislodgement of plates is seldom asymptomatic, although, there are reports of their spontaneous passage in feces, as well.…”

“…1,2 Complications of such instrumentation range from 2% to 35%. 1 The timing and rate of dislodgement determine the clinical presentation, treatment options, and morbidity/mortality, all of which vary widely.…”

“…1,2 Complications of such instrumentation range from 2% to 35%. 1 The timing and rate of dislodgement determine the clinical presentation, treatment options, and morbidity/mortality, all of which vary widely. Pharyngoesophageal injuries that occur during surgery present immediately, within hours/days, with neck collection, cervical abscess, subcutaneous emphysema, sepsis, or descending mediastinitis, with high morbidity and mortality.…”