Oral extrusion of a cervical screw: A rare late complication of anterior cervical discectomy and fusion.

Anterior cervical discectomy and fusion (ACDF) is a commonly used surgical technique for treating degenerative and traumatic conditions of the cervical spine. However, late-onset implant extrusions following this procedure are extremely rare but can lead to serious complications. In this case report, we present a 78-year-old male who presented to the emergency department with a sole complaint of hemoptysis, 16 years after undergoing ACDF surgery, and was found to have spontaneously expelled a screw through his mouth. Imaging studies revealed the anterior migration and pharyngeal extrusion of the cervical implant, which required surgical intervention. This case highlights that late implant migrations following ACDF may present solely with hemoptysis, in the absence of classical symptoms such as dysphagia or neck pain. This underscores the importance for emergency physicians to remain vigilant for such rare but significant complications.