B0253 - Although Rare, a Hardware Fracture and Migration of Anterior Cervical Spine Plating Can Present With Upper Gastrointestinal Bleeding and Associated With High Mortality

Introduction: Anterior cervical spine plating (ACSP) is a common surgical intervention indicated for many cervical osteopathologies. Esophageal perforation is a rare complication of ACSP that can occur shortly following surgery, due to over prominent screws or friction between the esophagus and the plate. Screw fracture and migration following the surgery is very rare but is a potentially life-threatening complication that can result in perforation of the adjacent organs like the esophagus and mediastinum, and increase the risk of infections in this area. (1-4)

Case Description/Methods: 84 year old male with cervical disc disease (C6-C7) status post ACSP (Anterior cervical spine plating ) with resultant need for a PEG tube placement secondary to newly developed severe oropharyngeal dysphagia after aforementioned spinal surgery with persistent aspiration, who presented with dark color liquid output coming out from the PEG tube.

Esophagogastroduodenoscopy (EGD) showed a foreign metal hardware (looks like cervical plate) seen embedded in the wall of the hypopharynx and eroding out, but no ulceration or blood was seen around the PEG insertion site.

CT cervical spine showed a fracture of the right C6 anterior fusion screw with evidence of anterior displacement of the fusion plate with 4 to 5 mm gap between the plate and the anterior margin of C6. Disc spacer material appears to extend beyond the anterior margin of the C6-7 disc space.

Discussion: Comprehensive surgical history is important for any patient presenting with evidence of upper gastrointestinal bleeding. Patients with a history of Anterior cervical spine plating (ACSP) need urgent cervical spine imaging to assess the status of the hardware, and if there are any radiologic features of infection. Cervical spine imaging will help to triage the urgency and type of intervention, whether conservative or urgent surgical intervention.