Yeh Mei-Yin, Huang Wen-Cheng, Kuo Chao-Hung, Chang Peng-Yuan, Cheng Henrich
Neurosurgery, Taipei Veterans General Hospital, Taipei, TWN.
Neurosurgery, Tao-Yuan General Hospital, Tao-Yuan, TWN.
Cureus. 2019 Jan 30;11(1):e3985. doi: 10.7759/cureus.3985.
Although cage subsidence and dislodgement are not uncommon in anterior cervical spine surgery, missing cages have seldom been reported. This is the first report of the disappearance of a metallic corpectomy cage after anterior cervical fusion. A 63-year-old man, who had a history of ankylosing spondylitis and diabetes mellitus, was involved in a motor vehicle accident that broke his neck. The traumatic C6 burst fracture caused myelopathy and instability, which required surgery. He then underwent anterior C6 corpectomy with circumferential fixation, including anterior plating and posterior lateral mass screws from C5-C7. There was a significant improvement in neurological function after the surgery and he could ambulate independently. However, upon a visit at six months postoperation, there was dislodgement of the anterior cervical plate and cage. An attempt to revise the anterior fusion construct was made subsequently, but this surgery could only remove the plate. The metallic cage was left in place during the revision surgery because it was firmly incorporated into the C5 and C7 vertebra and could hardly be adjusted intraoperatively. There were no other interventions during the interval. Upon his visit at 23 months after the initial surgery, the metallic cage was missing. No examinations could locate the cage anywhere in the body, including 36-inch radiographs that demonstrated completely the disappearance of the metallic corpectomy cage. The posterior arthrodesis seemed stable and the patient had no dysphagia or any other gastrointestinal symptoms. The process of the disappearance of the corpectomy cage was never noticed by the patient and he remains free of symptoms to date. The complete dislodgement of a cervical corpectomy cage that was placed anteriorly could happen without symptoms. The cage might have been expelled during bowel movements and caused little problem. Failure to achieve arthrodesis in anterior cervical fusion, therefore, must be closely monitored.
尽管颈椎前路手术中椎间融合器下沉和移位并不少见，但椎间融合器缺失的情况鲜有报道。本文首次报告了颈椎前路融合术后金属椎体切除椎间融合器消失的病例。一名63岁男性，有强直性脊柱炎和糖尿病病史，因机动车事故导致颈部骨折。创伤性C6爆裂骨折引起脊髓病和不稳定，需要手术治疗。随后他接受了C6椎体次全切除并环形固定，包括前路钢板固定和C5 - C7的后路侧块螺钉固定。术后神经功能有显著改善，他能够独立行走。然而，术后6个月复诊时，发现颈椎前路钢板和椎间融合器移位。随后尝试对前路融合结构进行翻修，但该手术只能取出钢板。翻修手术时金属椎间融合器留在原位，因为它已牢固地融合到C5和C7椎体中，术中几乎无法调整。在此期间没有进行其他干预。初次手术后23个月复诊时，金属椎间融合器不见了。包括能完整显示金属椎体切除椎间融合器消失的36英寸X线片在内的任何检查都未在体内找到该椎间融合器。后路融合似乎稳定，患者没有吞咽困难或任何其他胃肠道症状。患者从未注意到椎体切除椎间融合器消失的过程，至今仍无症状。前路放置的颈椎椎体切除椎间融合器完全移位可能没有症状。椎间融合器可能在排便时被排出，几乎没有造成问题。因此，颈椎前路融合术中未能实现融合必须密切监测。
