TRANSESOPHAGEAL SPONTANEOUS ELIMINATION O F AN ANTERIOR CERVICAL OSTEOSYNTHESIS

Purpose of the study The authors report a case of a wellkown but very unusual complication of cervical spine anterior osteosynthesis : spont aneous recurrent elimination of anterior fixation device through the g astrointestinal track, with good outcome. Materials and methods The pa tient (75 years old) was operated on for cervical myelopathia due to c ervical 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 uneventfu l. Plate incurvation and rupture were observed during the second post- operative month, with partial anterior migration of the lower screw. A s the patient complained of dysphagia, removal of osteosynthesis was d ecided and scheduled 3 days later; however the screw was missing on a pre-operative radiograph. It was found on a routine abdominal X-Ray, a nd it passed out during the following week. Dysphagia disappeared in a few days and removal of osteosynthesis was given up for fear of oesop hageal complications. Further evolution was favourable. Cervical fusio n was obtained uneventfully. Post-operative myelmogram showed a good c anal enlargment. The patient was temporarily lost for follow-up and wa s asked for review 2 years later. Mild difficulty in swallowing saliva was still present, without dysphagia. On routine cervical X-Rays anot her screw had disappeared again. Oesophagoscopy was proposed but not a ccepted by the patient because he felt not significantly disturbed. Di scussion and conclusion Complications associated with oesophageal perf oration may range from massive infection and death to spontaneous reso lution. Erosion due to extruded bulky contructs leads to persistant fi stula with abcess or septic diffusion. Perforation due to complete mig ration of small foreign bodies like screws gives possibility of sponta neous oesophageal closure and healing without significant morbidity. T he spontaneous recurrent elimination of 2 screws gives to this observa tion a very outstanding feature.