A Rare Case of Hypopharyngeal Screw Migration after Spine Stabilization with Plating

Anterior cervical spine fusion and stabilization with plating are well-established surgical procedures for the treatment of myelopathy, cervical spine traumas, and spinal infectious diseases. Various complications have been described in the literature, more frequently, intraoperative bleeding, peri- or postoperative hypopharyngeal, and/or esophageal ruptures with mediastinal deep infection and loosening and extrusion of the screws from the plating. Screw migration has also been observed as a complication of the procedure, either early in the postoperative period or delayed, even after many years. In some instances, the esophageal perforation can recover spontaneously with absence of complications, even if a case of plate failure and graft migration with lethal sudden airways obstruction has been reported. We describe a case of hypopharyngeal screw migration after cervical spine stabilization with plating never described before in the literature. 1. Introduction Due to the improved safety and outcomes, anterior surgical approaches to the cervical spine have gained popularity in the last decade. More commonly, the indications for this procedure are represented by cervical degenerative, neoplastic, and traumatic lesions. Several complications are reported, mostly due to bleeding and rupture of hypopharyngeal and/or esophageal walls with mediastinal deep infection and loosening and extrusion of the screws from the plating. Though rare, migration of the screw after plating has been reported [1–12], the site of migration being more frequently the esophagus. 2. Case Report A 65-years-old lady was referred to us from the Emergency Department, due to odynophagia, and sense of foreign body in her throat suddenly occurred 7 days before without any other symptom. Three years before, the patient underwent surgery with cervical spine stabilization with plating for C5-C6 disc herniation with a good outcome and absence of complications, apart from moderate dysphagia in the early postoperative period. A metallic foreign body (screw) was easily visible during laryngoscopy (Figure 1) in the postcricoid area, with only slight edema of the surrounding mucosa. An X-ray of the neck and a barium swallow confirmed the presence of the screw in the hypopharynx (Figure 2). Figure 1: At laryngoscopy, the upper part of the screw is clearly visible in the postcricoid area, just above the entrance of left pyriform sinus. Figure 2: X-ray with contrast medium: the arrow clearly indicates the migration of the screw from the prosthesis in posteroanterior, right lateral, and left lateral