Wong David T, Fehlings Michael G, Massicotte Eric M
Division of Neurosurgery, Department of Anesthesiology, University of Toronto, Ontario, Canada.
Spine (Phila Pa 1976). 2005 Nov 15;30(22):E683-6. doi: 10.1097/01.brs.0000186861.82651.00.
Case report of late postoperative complication.
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.
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.
He underwent surgical drainage of the abscess and had a good neurologic recovery.
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.
术后晚期并发症的病例报告。
已有多篇关于颈椎融合器械移位和脱出的报道。此类病例大多预后良好。据我们所知，颈椎器械脱出导致椎前脓肿和急性气道梗阻的情况尚未见报道。
一名56岁男性，曾接受过C3 - C6颈椎前路减压融合术，因吞咽困难和急性气道梗阻入院，需要紧急气管切开术。其颈部X线片显示与之前的片子相比，C6螺钉缺失。磁共振成像显示C2 - C7前方有一个巨大的椎前脓肿，导致上呼吸道完全梗阻。
他接受了脓肿的手术引流，神经功能恢复良好。
我们报告了一例因椎前脓肿导致急性上呼吸道梗阻的病例，可能继发于一枚松动的颈椎前路螺钉穿透椎前软组织。与文献中报道的器械脱出通常预后良好的病例不同，我们的病例呈现出危及生命的状况。
