Introduction: Screw migration after anterior cervical discectomy and fusion is rare and is usually related to device failure. It may provoke esophageal perforation and eventually the inadvertent expulsion of the screw through the gastrointestinal tract. As far as two cases of screw migration and hypopharynx perforation have been reported to date. We describe the first case of cervical interbody cage migration and oral expulsion.
Methods: A 59-year-old Caucasian female was operated in 2005 of a cervical tumour invading the vertebral body of C3. She underwent an anterior transmandibular approach achieving tumour resection and anterior stabilization with an interbody expandable cylinder device. Histological analysis evidenced a chordoma and the patient underwent subsequent intensity-modulated radiotherapy. Six years later she presented with tetraparesis that was related with tumor relapse. Again, she underwent a left anterolateral submandibular approach. Neurological recovery was complete.
Results: One year later the patient showed a new recurrence that invaded the vertebral bodies of C2 and C3. At this point a posterior approach was accomplished in order to resect the tumour and add spine stabilization C1-C6. The patient underwent adjuvant therapy with Cyberknife (re-irradiation with 30 Gy). Once the treatment had finished the patient noted progressive halitosis and dysphagia. She was attended at our centre after sudden extrusion of the titanium cylinder implanted in the first surgical procedure when she suffered a cough access that resulted in the device expulsion through the oral cavity. Fiber laryngoscope evaluation showed left hypopharynx widening and ipsilateral piriform recess collapse. Radiological studies showed a fistulous tract related to a decubitus ulcer in the posterior wall of the oropharynx as well as the extrusion of the interbody device in C3. The patient recovered uneventfully after conservative management and endovenous antibiotics.
Conclusions: Radiotherapy and progresssive tumour growth may have favoured the developement of an oropharyngeal ulcer and device migration respectively.
Patient Care: The research improve patient care by highlighting the importance of those entities that are unfrequent in the daily neurosurgical practice.
Learning Objectives: 1) recognize complications after cervical fusion procedures
2) review chordoma behavior and prognosis
3) discuss prevention of this particular complication