Wójtowicz Piotr, Szafarowski Tomasz, Migacz Ewa, Krzeski Antoni
ENT Department, Faculty of Medicine and Dentistry, Medical University of Warsaw, Stepinska Street 19/25, 00-739 Warsaw, Poland.
Case Rep Otolaryngol. 2015;2015:749463. doi: 10.1155/2015/749463. Epub 2015 Feb 10.
The anterior cervical spine surgery is a common procedure to stabilize vertebrae damaged by various diseases. The plates and screws are usually used in the spine fixation. This kind of instrumentation may detach from the bones which is a rare but well-known complication. A 77-year-old male presented to the otorhinolaryngology department with throat pain, choking, and dysphagia. At first the angioedema was diagnosed and he was treated conservatively. The endoscopy revealed laryngeal edema, being more defined on the right side with right vocal fold paresis. CT scans showed the stabilizing plate with two screws attached tightly and the back-out of the third screw toward soft tissue of the neck. In the meantime, his condition deteriorated and he needed tracheotomy. In few days the surgical removal of the dislocated screw was performed successfully. Although two-month follow-up reported no obstruction of the larynx, the vocal folds paresis with gradual functional improvement was observed. Long-term complication of anterior spine surgery sometimes may suggest laryngeal angioedema at first. If the conservative treatment is ineffective and there is a history of anterior spine surgery, the clinicians should consider the displacement of the plate or screws in differential diagnosis.
颈椎前路手术是一种常见的用于稳定因各种疾病而受损椎体的手术。钢板和螺钉通常用于脊柱固定。这种器械可能会从骨骼上脱离，这是一种罕见但广为人知的并发症。一名77岁男性因咽痛、吞咽困难和吞咽阻塞感就诊于耳鼻喉科。起初诊断为血管性水肿，并对其进行了保守治疗。内镜检查显示喉部水肿，右侧更为明显，右侧声带麻痹。CT扫描显示稳定钢板及两枚螺钉紧密附着，但第三枚螺钉向颈部软组织脱出。与此同时，他的病情恶化，需要进行气管切开术。几天后成功进行了脱位螺钉的手术取出。尽管两个月后的随访报告显示没有喉部梗阻，但观察到声带麻痹且功能逐渐改善。颈椎前路手术的长期并发症有时最初可能表现为喉部血管性水肿。如果保守治疗无效且有颈椎前路手术史，临床医生在鉴别诊断时应考虑钢板或螺钉移位的情况。
