Delayed anterior cervical plate dislodgement with pharyngeal wall perforation and oral extrusion of cervical plate screw after 8 years: A very rare complication
A 54-year-old gentleman with cervical compressive spondylotic myelopathy and multiple congenital anomalies of the cervical spine such as cranio-vertebral junction anomaly with occipit-C1 synostosis and C4-C5 fused vertebrae [] underwent C3 median corpectomy, gardening, iliac crest graft placement, and stabilization using titanium plate and screws from C2 to C4 vertebral bodies []. Postoperatively, he had improvement in his symptomatology. He reviewed after 8 years with complaint that a screw had expelled through his mouth while having food. There was history of progressive difficulty in swallowing with occasional regurgitation of feeds of 2 months duration. He had no history of recent trauma or worsening of power in his limbs. He was conscious and his neurological examination was normal except for exaggerated deep tendon reflexes. On oral examination, there was a defect in the posterior pharyngeal wall, through which cervical plate along with a missed fixation screw and intact self-locking screw was seen []. X-ray cervical spine lateral view showed anterior dislodgement and migration of the plate with a missing screw socket []. Oral culture was taken, and he was started on intravenous antibiotics, betadine oral gargles, and was fed through a nasogastric tube. At resurgery, no abnormal movement was seen, but the plate and screw system was loose and had migrated, with no evidence of fracture of the plate system. The plate was removed in toto after removing the screws []. As the patient had no new neurological deterioration and no abnormal movement was seen intraoperatively, no further instrumentation was done. He was planned for posterior fusion in case he developed new neurological deficits or signs of instability. Postoperatively there was no injury to the peripheral nerves or cranial nerves. Since the posterior pharyngeal wall defect was small, it was expected to close over a period of time; hence, no attempt was made to close it. Postoperatively he was continued on nasogastric tube feeding and intravenous antibiotics for 2 weeks. Regular inspections were made at the posterior pharyngeal wall to rule out fistula formation. The posterior pharyngeal wall defect had closed by 3 weeks without any gaping/fistula formation. At 11 months of follow-up, the patient is asymptomatic with normal lower cranial nerves’ function and with no signs of instability or new neurological deficits.