Asymptomatic esophageal perforation caused by late screw migration after anterior cervical plating: report of a case and review of relevant literature

• Published in: Spine (Philadelphia, Pa. 1976) Pa. 1976), 2002-12, Vol.27 (23), p.E499-E502
• Main Authors: Pompili, Alfredo, Canitano, Stefano, Caroli, Fabrizio, Caterino, Mauro, Crecco, Marcello, Raus, Laura, Occhipinti, Emanuele
• Format: Article
• Language: English
• Subjects: Bone Screws - adverse effects; Cervical Vertebrae - surgery; Esophageal Perforation - diagnosis; Esophageal Perforation - etiology; Foreign-Body Migration - diagnosis; Humans; Prosthesis Failure; Remission, Spontaneous; Spinal Fusion - adverse effects; Spinal Fusion - instrumentation; Spinal Osteophytosis - surgery; Time
• ISSN: 0362-2436; 1528-1159
• DOI: 10.1097/00007632-200212010-00016

This report documents a case of asymptomatic esophageal perforation, secondary to a dislocated and then migrated cervical screw after anterior plating, and reviews the relevant Western literature. To report a rare and potentially dangerous complication and suggest mechanisms of asymptomatic esophageal perforation and healing. Anterior surgical approaches to the cervical spine have become popular and safer during the past decade. Materials and devices for anterior stabilization have improved in quality and safety. Nevertheless, failure of the devices may occur either because of technical mistakes or rupture. Reoperation is not always necessary, as spontaneous recovery is possible. Our patient was operated on for severe cervical spondylotic myelopathy. One year after surgery, one of the screws migrated and was found anteriorly to the spine. Six months later, the screw could no longer be identified, and we concluded that an esophageal perforation had occurred and that the screw had been eliminated through the intestinal tract. The results of esophagoscopy were normal. The neurologic conditions of our patient improved constantly, and his spine alignment was maintained despite the missing screw. This case demonstrates that a serious complication may not need any treatment. Each case of screw displacement in anterior cervical spine surgery should be evaluated separately in conjunction with the clinical symptoms of the patient, as spontaneous resolution is possible.