Extrusión espontánea de material de artrodesis a través de orofaringe

Abstract

Introduction and objective: In the last 50 years, various anterior cervical approach techniques have been developed to treat a wide variety of pathologies. Radicular and anterior spinal cord compression are the most common indications for the anterior cervical approach. Anterior cervical spine surgery is a simple technique and a surgically safe procedure. Method: We present the case of an 84-year-old woman with a history of sensory-motor neuropathy, especially in MSI due to cervicoarthrosis with stenosis of the spinal canal and multiple joint holes. She was operated on by means of Anterior Cervical Arthrodesis post-C3-C4 discectomy in a private hospital in Madrid (January 2016), with postoperative complication of massive gastrointestinal bleeding secondary to pharyngeal laceration that required tracheotomy and reconstruction with muscle graft, and subsequent right laterocervical abscess with mediastinitis, which also required surgical intervention. Five years later, the patient came to our Emergency Department due to spontaneous extrusion of cervical arthrodesis material (intersomatic cage) through the oropharynx, after a coughing fit. The patient reported cervical discomfort, difficulty swallowing and previous coughing spells of approximately one month of duration (During that month, the patient went to the Emergency Department on one occasion due to pharyngeal discomfort, where an X-ray of the cervical spine was performed in wich, retrospectively, the migrating arthrodesis material can be seen. On that occasion the patient was discharged due to clinical improvement after analgesic treatment) The patient reported significant improvement in cervical discomfort after the expulsion of the arthrodesis material. Results: Given the possibility of the existence of wound or a fistula in the pharyngeal wall/upper airway, the patient was hospitalized for monitoring. A vigilant attitude was chosen, with oral intake being completely replaced by NGT feeding and administration of wide spectrum antibiotics. The patient had a favourable result with progression towards a full oral diet. There was evidence of improvement in clinical, examination and radiological image. She was discharged from hospital 2 weeks after admission. Currently the patient is asymptomatic. Conclusions: The review of the literature reveals an extensive list of complications in anterior cervical spine surgery, although many of them are extremely rare. The percentage of complications ranges between 0% and 30%. Complications derived from the arthrodesis material include plate fracture, breakage, extrusion of the screws, extrusion of the intersomatic cage… Apart from settling, the big problem with intersomatic cages is their displacement. There are few publications about the anterior extrusion of the cervical implants and less on posterior migrations with the subsequent neurological injury. In the literature review, migration has been reported to be between 0.4% and 4.6%. In our clinical case, the extrusion of the intersomatic cage occurred completely outwards through the oropharynx, spontaneously and without complications or sequelae.