Cervical spine osteosynthesis screw: a rare cause of late pharyngeal perforation
DOI:
https://doi.org/10.34631/sporl.2028Keywords:
late pharyngeal perforation, anterior cervical spine osteosynthesis, screwAbstract
Late-onset pharyngeal perforation is a rare complication of anterior cervical spine osteosynthesis. Clinical presentation is variable and may led to serious complications. We present a 49-year-old male patient with a six-week history of throat pain and foreign body sensation. He had a previous documented odontoid fracture treated with osteosynthesis with an interf ragmentary screw performed 30 years ago. A screw emerging at the level of the left tonsil was observed in the oropharynx, and it was inserted at the right postero-lateral hypopharyngeal wall. The integrity of the adjacent vessels was confirmed by imaging tests. The patient underwent screw removal by trans-oral approach with endoscopic observation, and was admitted for clinical surveillance, without further complications. The rarity of this condition hampers a consensus regarding the diagnostic and therapeutic approaches, and therefore, they must be individualized. In this clinical case, the patient was managed conservatively, and recovered without significant morbidity.
References
Phommachanh V, Patil YJ, McCaffrey TV, Vale F, Freeman TB, Padhya TA. Otolaryngologic management of delayed pharyngoesophageal perforation following anterior cervical spine surgery. Laryngoscope. 2010 May;120(5):930-6. doi: 10.1002/lary.20747.
Kapu R, Singh M, Pande A, Vasudevan MC, Ramamurthi R. Delayed anterior cervical plate dislodgement with pharyngeal wall perforation and oral extrusion of cervical plate screw after 8 years: a very rare complication. J Craniovertebr Junction Spine. 2012 Jan;3(1):19-22. doi: 10.4103/0974-8237.110121
Rama-López J, Tomás-Fernandez M, García-Garza C, Martínez-Madrigal M. Pharyngeal perforation after anterior cervical spine surgery treated by transoral endoscopic surgery. Head Neck. 2018 Feb;40(2):E13-E16. doi: 10.1002/hed.25030.
Geyer TE, Foy MA. Oral extrusion of a screw after anterior cervical spine plating. Spine (Phila Pa 1976). 2001 Aug 15;26(16):1814-6. doi: 10.1097/00007632-200108150-00019.
Lee JS, Kang DH, Hwang SH, Han JW. Oral extrusion of screw after anterior cervical interbody. J Korean Neurosurg Soc. 2008 Oct;44(4):259-61. doi: 10.3340/jkns.2008.44.4.259
Quadri SA, Capua J, Ramakrishnan V, Sweiss R, Cabanne M, Noel J. et al. A rare case of pharyngeal perforation and expectoration of an entire anterior cervical fixation construct. J Neurosurg Spine. 2017 May;26(5):560-566. doi: 10.3171/2016.10.SPINE16560.
Sharma RR, Sethu AU, Lad SD, Turel KE, Pawar SJ. Pharyngeal perforation and spontaneous extrusion of the cervical graft with its fixation device: a late complication of C2-C3 fusion via anterior approach. J Clin Neurosci. 2001 Sep;8(5):464-8. doi: 10.1054/jocn.2000.0826.
Newhouse KE, Lindsey RW, Clark CR, Lieponis J, Murphy MJ. Esophageal perforation following anterior cervical spine surgery. Spine (Phila Pa 1976). 1989 Oct;14(10):1051-3. doi: 10.1097/00007632-198910000-00004.
Wong DT, Fehlings MG, Massicotte EM. Anterior cervical screw extrusion leading to acute upper airway obstruction: case report. Spine (Phila Pa 1976). 2005 Nov 15;30(22):E683-6. doi: 10.1097/01.brs.0000186861.82651.00.
Yin DH, Yang XM, Huang Q, Yang M, Tang QL, Wang SH. et al. Pharyngoesophageal perforation 3 years after anterior cervical spine surgery: a rare case report and literature review. Eur Arch Otorhinolaryngol. 2015 Aug;272(8):2077-82. doi: 10.1007/s00405-014-3483-7
Woolley SL, Smith DR. Pharyngeal perforation: a late complication of cervical spine surgery. J Laryngol Otol. 2005 Nov;119(11):913-6. doi: 10.1258/002221505774783386.
Moletta L, Pierobon ES, Salvador R, Volpin F, Finocchiaro FM, Capovilla G. et al. Pharyngo-esophageal perforation following anterior cervical spine surgery: a single center experience and a systematic review of the literature. Global Spine J. 2022 May;12(4):719-731. doi: 10.1177/21925682211005737
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