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CC BY-NC-ND 4.0 · Asian J Neurosurg 2021; 16(01): 196-199
DOI: 10.4103/ajns.AJNS_230_19
Case Report

Pharyngocutaneous fistula and horner's syndrome following loosening of locking screw of anterior cervical plating: A rare case report and management

Abhinav Jogani
Department of Orthopaedics, Seth G.S. Medical College and KEM Hospital, Mumbai, Maharashtra
,
Tushar Rathod
Department of Orthopaedics, Seth G.S. Medical College and KEM Hospital, Mumbai, Maharashtra
,
Nandan Marathe
Department of Orthopaedics, Seth G.S. Medical College and KEM Hospital, Mumbai, Maharashtra
,
Shubhranshu Mohanty
Department of Orthopaedics, Seth G.S. Medical College and KEM Hospital, Mumbai, Maharashtra
,
Chetan Shende
Department of Orthopaedics, Seth G.S. Medical College and KEM Hospital, Mumbai, Maharashtra
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We hereby present a rare case of pharyngocutaneous fistula associated with locking screw loosening causing internal cricopharynx perforation and Horner's syndrome following anterior cervical plating. A 27-year-old male patient had undergone anterior cervical plating at C5–C7 level due to gunshot injury to the neck, and 1 month postsurgery, he developed fistula in the neck showing discharge of consumed food contents. He presented to us 1 year postsurgery with the discharging fistula, left upper-limb weakness, and Horner's syndrome that developed after surgery. The previously unexplored right side was used to remove implant, and owing to solid union at corpectomy, no additional fixation was performed. Intraoperatively, pharyngeal wall dehiscence was observed. Attempt of removal of impinged screw was abandoned since it migrated into the esophagus. Serial abdomen radiographs revealed successive passage of screw through the gastrointestinal (GI) tract until it could not be visualized. As the patient showed reduced discharge, a GI surgeon gave a conservative trial with nasogastric intubation. Currently, fistula is showing minimal discharge with no food. Having knowledge of this possible rare outcome and awareness of various multidisciplinary approaches for management makes practicing spine surgeon equipped to handle such undesirable complications.

Key-words:

Anterior cervical plating - fistula - locking mechanism

Financial support and sponsorship

Nil.




Publication History

Received: 18 July 2020

Accepted: 26 March 2020

Article published online:
16 August 2022

© 2021. Asian Congress of Neurological Surgeons. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

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  • References

  • 1 Smith GW, Robinson RA. The treatment of certain cervical-spine disorders by anterior removal of the intervertebral disc and interbody fusion. J Bone Joint Surg Am 1958;40-A:607-24.
  • 2 Bailey RW, Badgley CE. Stabilization of the cervical spine by anterior fusion. J Bone Joint Surg Am 1960;42-A:565-94.
  • 3 Cloward RB. Vertebral body fusion for ruptured cervical discs. Am J Surg 1959;98:722-7.
  • 4 Cloward RB. Treatment of acute fractures and fracture-dislocations of the cervical spine by vertebral-body fusion. A report of eleven cases. J Neurosurg 1961;18:201-9.
  • 5 Kaiser MG, Haid RW Jr., Subach BR, Barnes B, Rodts GE Jr. Anterior cervical plating enhances arthrodesis after discectomy and fusion with cortical allograft. Neurosurgery 2002;50:229-36.
  • 6 Panjabi MM, Isomi T, Wang JL. Loosening at the screw-vertebra junction in multilevel anterior cervical plate constructs. Spine (Phila Pa 1976) 1999;24:2383-8.
  • 7 Cloward RB. Complications of anterior cervical disc operation and their treatment. Surgery 1971;69:175-82.
  • 8 Newhouse KE, Lindsey RW, Clark CR, Lieponis J, Murphy MJ. Esophageal perforation following anterior cervical spine surgery-CSRS survey. Spine 1989;14:1051-3.
  • 9 Simon C, Fürstenberg CH, Eichler M, Rohde S, Bulut C, Wiedenhöfer B. Management of Pharyngeal Fistulas After Anterior Cervical Spine Surgery: A Treatment Algorithm for Severe Complications. Clin Spine Surg 2017;30:E25-30.
  • 10 Iyoob VA. Postoperative pharyngocutaneous fistula: Treated by sternocleidomastoid flap repair and cricopharyngeus myotomy. Eur Spine J 2013;22:107-12.
  • 11 Navarro R, Javahery R, Eismont F, Arnold DJ, Bhatia NN, Vanni S, et al. The role of the sternocleidomastoid muscle flap for esophageal fistula repair in anterior cervical spine surgery. Spine (Phila Pa 1976) 2005;30:E617-22.
  • 12 Benazzo M, Spasiano R, Bertino G, Occhini A, Gatti P. Sternocleidomastoid muscle flap in esophageal perforation repair after cervical spine surgery: Concepts, techniques, and personal experience. J Spinal Disord Tech 2008;21:597-605.
  • 13 Al-Mourgi M. Sternocleidomastoid flap for repair of pharyngocutaneous fistula following anterior cervical spine surgery. Saudi J Health Sci 2015;4:199-201.