Removal of a Floating and Migrated Plate Screw in a Patient with a Failed Anterior Cervical Discectomy and Fusion.
Anterior cervical discectomy and fusion
Cervical spine
Esophagus
Neck surgery
Screw loosening
Screw migration
Spine surgery
Journal
World neurosurgery
ISSN: 1878-8769
Titre abrégé: World Neurosurg
Pays: United States
ID NLM: 101528275
Informations de publication
Date de publication:
Jul 2023
Jul 2023
Historique:
received:
02
03
2023
accepted:
24
03
2023
medline:
28
6
2023
pubmed:
2
4
2023
entrez:
1
4
2023
Statut:
ppublish
Résumé
Anterior cervical discectomy and fusion (ACDF) is a commonly performed procedure for degenerative cervical spine disease. Rare complications of ACDF surgery include hardware failure, in the form of screw loosening and migration, or rod breakage. We present a case in which we removed a migrated screw lodged in the esophagus from a patient with a failed anterior cervical fusion. To present a surgical technique and considerations to remove a migrated screw. The previous ACDF incision was reopened and exposure was gained under the guidance of a head and neck surgeon. Longus coli were mobilized off the spine bilaterally with electrocautery. After dissection, the screw was found lodged in the longitudinal muscle of the esophageal wall and excised with the use of a 15-blade. The integrity of the esophageal mucosa and submucosa was maintained and subsequently checked with rigid esophagoscopy. Fluoroscopy was used to confirm that all hardware was removed, with the exception of the anterior cages. The dislodged screw, which was embedded in the esophagus, was successfully removed. Failure of an ACDF carries a risk of screw migration, which may be asymptomatic even if the screw is lodged in the esophagus. Additional considerations are required with potential violations of the adjacent viscera.
Sections du résumé
BACKGROUND
BACKGROUND
Anterior cervical discectomy and fusion (ACDF) is a commonly performed procedure for degenerative cervical spine disease. Rare complications of ACDF surgery include hardware failure, in the form of screw loosening and migration, or rod breakage. We present a case in which we removed a migrated screw lodged in the esophagus from a patient with a failed anterior cervical fusion.
OBJECTIVE
OBJECTIVE
To present a surgical technique and considerations to remove a migrated screw.
METHODS
METHODS
The previous ACDF incision was reopened and exposure was gained under the guidance of a head and neck surgeon. Longus coli were mobilized off the spine bilaterally with electrocautery. After dissection, the screw was found lodged in the longitudinal muscle of the esophageal wall and excised with the use of a 15-blade. The integrity of the esophageal mucosa and submucosa was maintained and subsequently checked with rigid esophagoscopy. Fluoroscopy was used to confirm that all hardware was removed, with the exception of the anterior cages.
RESULTS
RESULTS
The dislodged screw, which was embedded in the esophagus, was successfully removed.
CONCLUSIONS
CONCLUSIONS
Failure of an ACDF carries a risk of screw migration, which may be asymptomatic even if the screw is lodged in the esophagus. Additional considerations are required with potential violations of the adjacent viscera.
Identifiants
pubmed: 37003529
pii: S1878-8750(23)00425-4
doi: 10.1016/j.wneu.2023.03.101
pii:
doi:
Types de publication
Case Reports
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
98-101Informations de copyright
Copyright © 2023 Elsevier Inc. All rights reserved.