Anterior Cervical Screw Extrusion Leading to Acute Upper Airway Obstruction

In Brief 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.