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Late-Onset Dysphagia From Hardware Migration After Anterior Cervical Discectomy and Fusion: An Unusual Cause and Review of Literature.

ABSTRACT: Post-operative dysphagia is the most common complication following anterior cervical discectomy and fusion (ACDF), with reports varying from 1% to 79%. We report a case of a 63-year-old female patient complaining of dysphagia presenting 9?years post surgery. The cause of dysphagia is often multifactorial with the true aetiology poorly understood. One potentially life-threatening cause of post-operative dysphagia is hardware migration associated with pharyngoesophageal perforation. This patient presents a unique case of a conservatively managed hardware migration with delayed onset dysphagia after 8?years of minimal symptoms. On further investigation, barium swallow identified a freely mobile screw in the oesophageal submucosa, rotating on swallowing. Retrieval of the screw was achieved transcervically with no visible perforation and resolution of dysphagia occurred 1?week post-operatively. Understanding the aetiology with early diagnosis and appropriate management of delayed hardware migration are paramount in reducing patient morbidity and potential life-threatening otolaryngologic complications.

SUBMITTER: Fryer C

PROVIDER: S-EPMC6791042 | biostudies-literature | 2019

REPOSITORIES: biostudies-literature

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Late-Onset Dysphagia From Hardware Migration After Anterior Cervical Discectomy and Fusion: An Unusual Cause and Review of Literature.

Fryer Callum C Tan Hsern Ern HE Bakmeedeniya Roshitha R Friedland Peter Leon PL

Clinical medicine insights. Ear, nose and throat 20191011

Post-operative dysphagia is the most common complication following anterior cervical discectomy and fusion (ACDF), with reports varying from 1% to 79%. We report a case of a 63-year-old female patient complaining of dysphagia presenting 9 years post surgery. The cause of dysphagia is often multifactorial with the true aetiology poorly understood. One potentially life-threatening cause of post-operative dysphagia is hardware migration associated with pharyngoesophageal perforation. This patient p ...[more]

PMID: 31656397

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Project description:BackgroundAnterior cervical discectomy and fusion is a standard surgical treatment for cervical radiculopathy and myelopathy, but reoperations sometimes are performed to treat complications of fusion such as pseudarthrosis and adjacent-segment degeneration. A cervical disc arthroplasty is designed to preserve motion and avoid the shortcomings of fusion. Available evidence suggests that a cervical disc arthroplasty can provide pain relief and functional improvements similar or superior to an anterior cervical discectomy and fusion. However, there is controversy regarding whether a cervical disc arthroplasty can reduce the frequency of reoperations.Questions/purposesWe performed a meta-analysis of randomized controlled trials (RCTs) to compare cervical disc arthroplasty with anterior cervical discectomy and fusion regarding (1) the overall frequency of reoperation at the index and adjacent levels; (2) the frequency of reoperation at the index level; and (3) the frequency of reoperation at the adjacent levels.MethodsPubMed, EMBASE, and the Cochrane Register of Controlled Trials databases were searched to identify RCTs comparing cervical disc arthroplasty with anterior cervical discectomy and fusion and reporting the frequency of reoperation. We also manually searched the reference lists of articles and reviews for possible relevant studies. Twelve RCTs with a total of 3234 randomized patients were included. Eight types of disc prostheses were used in the included studies. In the anterior cervical discectomy and fusion group, autograft was used in one study and allograft in 11 studies. Nine of 12 studies were industry sponsored. Pooled risk ratio (RR) and associated 95% CI were calculated for the frequency of reoperation using random-effects or fixed-effects models depending on the heterogeneity of the included studies. A funnel plot suggested the possible presence of publication bias in the available pool of studies; that is, the shape of the plot suggests that smaller negative or no-difference studies may have been performed but have not been published, and so were not identified and included in this meta-analysis.ResultsThe overall frequency of reoperation at the index and adjacent levels was lower in the cervical disc arthroplasty group (6%; 108/1762) than in the anterior cervical discectomy and fusion group (12%; 171/1472) (RR, 0.54; 95% CI, 0.36-0.80; p = 0.002). Subgroup analyses were performed according to secondary surgical level. Compared with anterior cervical discectomy and fusion, cervical disc arthroplasty was associated with fewer reoperations at the index level (RR, 0.50; 95% CI, 0.37-0.68; p < 0.001) and adjacent levels (RR, 0.52; 95% CI, 0.37-0.74; p < 0.001).ConclusionsCervical disc arthroplasty is associated with fewer reoperations than anterior cervical discectomy and fusion, indicating that it is a safe and effective alternative to fusion for cervical radiculopathy and myelopathy. However, because of some limitations, these findings should be interpreted with caution. Additional studies are needed.Level of evidenceLevel I, therapeutic study.

Dataset Information

Late-Onset Dysphagia From Hardware Migration After Anterior Cervical Discectomy and Fusion: An Unusual Cause and Review of Literature.

Publications

Late-Onset Dysphagia From Hardware Migration After Anterior Cervical Discectomy and Fusion: An Unusual Cause and Review of Literature.

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