STUDY DESIGN: Case report of late postoperative complication. SUMMARY OF BACKGROUND DATA: There have been a number of reports of migration and extrusion of cervical fusion instrumentation. The majority of such cases have a benign outcome. To our knowledge, cervical instrumentation extrusion resulting in prevertebral abscess and acute airway obstruction has not been reported. METHODS: A 56-year-old man who had undergone a prior C3-C6 anterior cervical decompression and fusion presented to a hospital with dysphagia and acute airway obstruction requiring an emergency tracheostomy. His neck radiograph showed that a C6 screw was missing compared to prior films. Magnetic resonance imaging showed a large prevertebral abscess anterior to C2-C7 causing complete upper airway obstruction. RESULTS: He underwent surgical drainage of the abscess and had a good neurologic recovery. CONCLUSIONS: We report a case of acute upper airway obstruction from prevertebral abscess, likely secondary to a loosened anterior cervical screw penetrating the prevertebral soft tissue. In contrast to case reports in the literature involving instrumentation extrusion with a usually benign outcome, our case presented with a life-threatening condition.
STUDY DESIGN: Case report of late postoperative complication. SUMMARY OF BACKGROUND DATA: There have been a number of reports of migration and extrusion of cervical fusion instrumentation. The majority of such cases have a benign outcome. To our knowledge, cervical instrumentation extrusion resulting in prevertebral abscess and acute airway obstruction has not been reported. METHODS: A 56-year-old man who had undergone a prior C3-C6 anterior cervical decompression and fusion presented to a hospital with dysphagia and acute airway obstruction requiring an emergency tracheostomy. His neck radiograph showed that a C6 screw was missing compared to prior films. Magnetic resonance imaging showed a large prevertebral abscess anterior to C2-C7 causing complete upper airway obstruction. RESULTS: He underwent surgical drainage of the abscess and had a good neurologic recovery. CONCLUSIONS: We report a case of acute upper airway obstruction from prevertebral abscess, likely secondary to a loosened anterior cervical screw penetrating the prevertebral soft tissue. In contrast to case reports in the literature involving instrumentation extrusion with a usually benign outcome, our case presented with a life-threatening condition.
Authors: Joshua Schroeder; Stephan N Salzmann; Alexander P Hughes; James D Beckman; Jennifer Shue; Federico P Girardi Journal: World J Orthop Date: 2017-06-18