Cervical Screw Extrusion Into the Trachea Leading to Perforation: A Case Report

Abstract

There have been a number of reports of migration and extrusion of cervical instrumentation. To our knowledge, cervical instrumentation extrusion resulting acute airway obstruction has been quite rare reported. We present case report of late postoperative complication of cervical plate-screw application. A 77-year-old woman was admitted with a complaint of dyspnea for the past one week and sore throat. Ten years before the presentation she underwent cervical C3-C6 plate and screws application after serious cervical trauma. Plane radiography of the cervical spine showed four screws; two into C3 vertebral body and two partially extruded from C6 vertebral bodies. Sagittal Imaging of Chest Computerized Tomography showed one screw extruded from C6 vertebral body into the trachea. The patient was operated via anterior cervical approach and the plate and screws were visualized at the level of C3 and C6 vertebral body. The extruded screw was taken out from the C6 vertebral body and the opening of the tracheal wall was repaired by using a piece of muscle patch and fibrin glue. Cervical metallic implants have some potential complications during and after the surgical procedure. Multilevel plate placement is more prone to such kind of complications because of biomechanical properties.