Progressive Dysphagia in a Patient With a History of Cervical Spine Fusion

Azadarmaki, Roya; Soliman, Ahmed M. S.

doi:10.1001/jamaoto.2014.787

Cited by 3 publications

(3 citation statements)

References 9 publications

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“…Several reports exist in the literature of screw pullout resulting in dysphagia and sometimes erosion into the gastrointestinal tract. 53 -55 They continue to document the incidence of screw pullout related to misplacement to be uncommon, but can result in complications with serious morbidity and increased costs.…”

Section: Discussionmentioning

confidence: 99%

Misplaced Cervical Screws Requiring Reoperation

Peterson

Arnold

Smith

et al. 2017

Global Spine Journal

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Study Design:A multicenter, retrospective case series.Objective:In the past several years, screw fixation of the cervical spine has become commonplace. For the most part, this is a safe, low-risk procedure. While rare, screw backout or misplaced screws can lead to morbidity and increased costs. We report our experiences with this uncommon complication.Methods:A multicenter, retrospective case series was undertaken at 23 institutions in the United States. Patients were included who underwent cervical spine surgery from January 1, 2005, to December 31, 2011, and had misplacement of screws requiring reoperation. Institutional review board approval was obtained at all participating institutions, and detailed records were sent to a central data center.Results:A total of 12 903 patients met the inclusion criteria and were analyzed. There were 11 instances of screw backout requiring reoperation, for an incidence of 0.085%. There were 7 posterior procedures. Importantly, there were no changes in the health-related quality-of-life metrics due to this complication. There were no new neurologic deficits; a patient most often presented with pain, and misplacement was diagnosed on plain X-ray or computed tomography scan. The most common location for screw backout was C6 (36%).Conclusions:This study represents the largest series to tabulate the incidence of misplacement of screws following cervical spine surgery, which led to revision procedures. The data suggest this is a rare event, despite the widespread use of cervical fixation. Patients suffering this complication can require revision, but do not usually suffer neurologic sequelae. These patients have increased cost of care. Meticulous technique and thorough knowledge of the relevant anatomy are the best means of preventing this complication.

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Section: Discussionmentioning

confidence: 99%

Misplaced Cervical Screws Requiring Reoperation

Peterson

Arnold

Smith

et al. 2017

Global Spine Journal

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“…Anterior hardware migration may play a role in the multifactorial nature of many postulated causes of dysphagia. 14,15 In our patient, the multifactorial nature of her dysphagia included extensive spinal surgery over multiple levels, chronic gastroesophageal reflux disease with a hiatus hernia, a significant smoking history as well as hardware migration.…”

Section: Discussionmentioning

confidence: 88%

Late-Onset Dysphagia From Hardware Migration After Anterior Cervical Discectomy and Fusion: An Unusual Cause and Review of Literature

Fryer

Tan

Bakmeedeniya

et al. 2019

Clin Med Insights Ear Nose Throat

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Post-operative dysphagia is the most common complication following anterior cervical discectomy and fusion (ACDF), with reports varying from 1% to 79%. We report a case of a 63-year-old female patient complaining of dysphagia presenting 9 years post surgery. The cause of dysphagia is often multifactorial with the true aetiology poorly understood. One potentially life-threatening cause of post-operative dysphagia is hardware migration associated with pharyngoesophageal perforation. This patient presents a unique case of a conservatively managed hardware migration with delayed onset dysphagia after 8 years of minimal symptoms. On further investigation, barium swallow identified a freely mobile screw in the oesophageal submucosa, rotating on swallowing. Retrieval of the screw was achieved transcervically with no visible perforation and resolution of dysphagia occurred 1 week post-operatively. Understanding the aetiology with early diagnosis and appropriate management of delayed hardware migration are paramount in reducing patient morbidity and potential life-threatening otolaryngologic complications.

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“…Screw loosening and plate migration in the anterior cervical discectomy fusion (ACDF) is not rare (Ning et al, 2008;Guo et al, 2021), even though hardware failure attributed to ACDF was demonstrated only 0.1%-0.9% in the United States (Epstein, 2019). Many clinical case reports revealed that screw loosening and anterior cervical plate migration happened in ACDF (Azadarmaki and Soliman, 2014;Nathani et al, 2015;Wójtowicz et al, 2015;Fryer et al, 2019;Ansari et al, 2020). Screw loosening in ACDF is one of the most dangerous complications in cervical anterior plating fixation, which may lead to severe consequences such as esophageal perforation and bone nonunion (Ning et al, 2008;Hershman et al, 2017;Fryer et al, 2019).…”

Section: Introductionmentioning

confidence: 99%

Patient-specific numerical investigation of the correction of cervical kyphotic deformity based on a retrospective clinical case

Chen

Sun

et al. 2022

Front. Bioeng. Biotechnol.

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Little research has been reported on evaluating the safety of the fixation construct in cervical kyphosis correction. In this study, we proposed a principal-strain criterion to evaluate the safety of the fixation construct and validated the modeling method against a retrospective case of anterior cervical discectomy fusion (ACDF). From C2 to T2 vertebra bodies, fixation instruments were reconstructed and positioned as per postoperative computed tomography (CT) scans. Head weight (HW) and various moments estimated from isometric strength data were imposed onto the C2. The postoperative stability of non-surgical segments, deformations surrounding the screw trajectories, and contact slipping on zygapophysial joints were analyzed. The model was validated against the reality that the patient had a good fusion and deformity correction. The ACDF restricted the range of motions (ROMs) of cervical segments and lent stability to vertebra fusion, no failure was found in the finite element (FE) model of cervical vertebrae. The deformation surrounding the screw trajectories were concentrated to the lateral sides of trajectories, recommending that the shape of the anterior cervical plate conforming to the curvature of the vertebra and screws fully inserted into vertebrae reduced the deformation concentration around the screw trajectories.

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Progressive Dysphagia in a Patient With a History of Cervical Spine Fusion

Cited by 3 publications

References 9 publications

Misplaced Cervical Screws Requiring Reoperation

Misplaced Cervical Screws Requiring Reoperation

Late-Onset Dysphagia From Hardware Migration After Anterior Cervical Discectomy and Fusion: An Unusual Cause and Review of Literature

Patient-specific numerical investigation of the correction of cervical kyphotic deformity based on a retrospective clinical case

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