Pharyngeal penetration of a dislocated screw after anterior cervical spine fusion

The anterior cervical spine fusion is a common method to stabilize the cervical spine in various pathologies (instability in fractures, dislocations, degenerative change). Complications in the form of dysphagia with foreign body sensation, neck and chest pain due to dislodged screws are rare. The following complications are also described: liquor leakage, recurrent laryngeal injuries, pharyngoesophageal injuries, pre-vertebral abscesses, airway obstruction, mediastinitis and rupture of the carotid artery.

A 58-year-old male patient presented with an anteriorly dislocated screw into the pharynx after "anterior cervical spondylodesis revision". He reported foreign body sensation and sore throat.

An accomplished CT neck examination confirmed this. The screw could be removed intraoperatively. Antibiotic therapy was prophylactic with clindamycin and metronidazole. For oral nutrition, a gastric tube was placed for protection. A control CT neck examination showed a complication-free course. The discharge took place after 6 days.

Foreign bodies after anterior cervical spine fusion in the area of ​​the larynx and cervical soft tissue can have serious consequences. It may cause nerve and vascular injury with the resulting complications: inflammation, esophageal injury with perforation and mediastinitis, and the need for tracheotomy for recurrent nerve injury. Rarely, respiratory injuries are described.

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Publication History

Article published online:
10 June 2020