Secondary Logo

Journal Logo

Institutional members access full text with Ovid®

Anterior Cervical Screw Extrusion Leading to Acute Upper Airway Obstruction: Case Report

Wong, David T., MD*; Fehlings, Michael G., MD, PhD, FRCSC; Massicotte, Eric M., MD, FRCSC

doi: 10.1097/01.brs.0000186861.82651.00
Case Report

Study Design. Case report of late postoperative complication.

Summary of Background Data. There have been a number of reports of migration and extrusion of cervical fusion instrumentation. The majority of such cases have a benign outcome. To our knowledge, cervical instrumentation extrusion resulting in prevertebral abscess and acute airway obstruction has not been reported.

Methods. A 56-year-old man who had undergone a prior C3–C6 anterior cervical decompression and fusion presented to a hospital with dysphagia and acute airway obstruction requiring an emergency tracheostomy. His neck radiograph showed that a C6 screw was missing compared to prior films. Magnetic resonance imaging showed a large prevertebral abscess anterior to C2–C7 causing complete upper airway obstruction.

Results. He underwent surgical drainage of the abscess and had a good neurologic recovery.

Conclusions. We report a case of acute upper airway obstruction from prevertebral abscess, likely secondary to a loosened anterior cervical screw penetrating the prevertebral soft tissue. In contrast to case reports in the literature involving instrumentation extrusion with a usually benign outcome, our case presented with a life-threatening condition.

A 56-year-old man presented with 4-year post-anterior cervical decompression and fusion with a large prevertebral abscess and acute upper airway obstruction requiring emergency tracheostomy. Previous reports of cervical instrumentation extrusion showed a usually benign outcome. To our knowledge this is the first case report describing a delayed prevertebral abscess leading to life threatening airway complication.

From the Departments of *Anesthesiology and †Surgery, Division of Neurosurgery, University of Toronto, Ontario, Canada.

Acknowledgment date: June 16, 2004. First revision date: July 27, 2004. Acceptance date: February 14, 2005.

Supported by the Department of Anesthesiology, Toronto Western Hospital, University Health Network, University of Toronto, Toronto, Canada.

The manuscript submitted does not contain information about medical device(s)/drug(s).

No funds were received in support of this work. No benefits in any form have been or will be received from a commercial party related directly or indirectly to the subject of this manuscript.

Address correspondence and reprint requests to David T. Wong, MD, Department of Anesthesiology, Toronto Western Hospital, 399 Bathurst Street, Toronto, Ontario, Canada M5T 2S8; E-mail:

© 2005 Lippincott Williams & Wilkins, Inc.