Sath S
Department of Spine Services, Indian Spinal Injuries Centre, New Delhi, India.
Malays Orthop J. 2020 Nov;14(3):184-187. doi: 10.5704/MOJ.2011.031.
Complications in the form of esophageal injury, tracheal injury, injury to carotids, implant failure, loosening of screws, etc do occur after anterior cervical surgeries. Although intra-operative esophageal injuries are as such rare, there have been few reports of delayed esophageal perforation as well after anterior cervical surgeries. We report a very rare case of migration of missing screw from anterior cervical plate after anterior cervical corpectomy and plating, which had ultimately migrated down to colon and had to be removed via colonoscopy. Along with removal of migrated screw from colon, revision of failed anterior cervical surgery was done wherein plate and screws were removed with mesh cage left in-situ as it was snug-fit while pharyngeophageal perforation was explored and was found to be spontaneously healing, with addition of posterior Bohlman's interspinous wiring for added stability. Migration of screw from the anterior cervical plate into the colon although very rare, should be always kept in mind and its potentially serious complications. We also conclude that particular attention should be given to elderly people with poor bony quality who have high chances of implant failure, along with attention to proper cage size, screw position and proper locking of the screw to further lessen the chances of implant failure.
颈椎前路手术后确实会出现食管损伤、气管损伤、颈动脉损伤、植入物失败、螺钉松动等并发症。虽然术中食管损伤本身很少见，但也有少数关于颈椎前路手术后延迟性食管穿孔的报道。我们报告了一例非常罕见的病例，在颈椎椎体次全切除并植骨融合内固定术后，一枚缺失的螺钉从颈椎前路钢板移位，最终移位至结肠，不得不通过结肠镜检查取出。在从结肠取出移位螺钉的同时，对失败的颈椎前路手术进行了翻修，术中取出钢板和螺钉，由于网笼贴合良好，故保留原位，同时探查咽食管穿孔，发现其正在自行愈合，并增加了后路Bohlman棘突间钢丝固定以增强稳定性。虽然螺钉从颈椎前路钢板移位至结肠非常罕见，但应始终牢记这一情况及其可能导致的严重并发症。我们还得出结论，对于骨质质量差、植入物失败几率高的老年人，应特别关注，同时要注意合适的椎间融合器尺寸、螺钉位置以及螺钉的正确锁定，以进一步降低植入物失败的几率。
