[Spontaneous elimination by the natural tracts of screws of anterior cervical osteosynthesis. Apropos of a case].

PURPOSE OF THE STUDY: The authors report a case of a wellknown but very unusual complication of cervical spine anterior osteosynthesis: spontaneous recurrent elimination of anterior fixation device through the gastrointestinal track, with good outcome.

MATERIALS AND

METHODS

The patient (75 years old) was operated on for cervical myelopathia due to cervical stenosis. Surgical treatment included an anterior release with corporectomy of C4, C5 and C6 and iliac graft insertion, and fixation using plate and screws. Immediate post-operative course was uneventful. Plate incurvation and rupture were observed during the second post-operative month, with partial anterior migration of the lower screw. As the patient complained of dysphagia, removal of osteosynthesis was decided and scheduled 3 days later; however the screw was missing on a pre-operative radiograph. It was found on a routine abdominal X-Ray, and it passed out during the following week. Dysphagia disappeared in a few days and removal of osteosynthesis was given up for fear of oesophageal complications. Further evolution was favourable. Cervical fusion was obtained uneventfully. Post-operative myelmogram showed a good canal enlargement. The patient was temporarily lost for follow-up and was asked for review 2 years later. Mild difficulty in swallowing saliva was still present without dysphagia. On routine cervical X-Rays another screw had disappeared again. Oesophagoscopy was proposed but not accepted by the patient because he felt not significantly disturbed.

DISCUSSION AND

CONCLUSION

Complications associated with oesophageal perforation may range from massive infection and death to spontaneous resolution. Erosion due to extruded bulky constructs leads to persistent fistula with abscess or septic diffusion. Perforation due to complete migration of small foreign bodies like screws gives possibility of spontaneous oesophageal closure and healing without significant morbidity. The spontaneous recurrent elimination of 2 screws gives to this observation a very outstanding feature.