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Unusual Problem after a Cervical Spine Fusion

Most medical research involves studying large numbers of patients. But sometimes a case is so unusual that doctors will report on just one patient. This is one of those articles. This case report describes the treatment for a 67-year-old man who had neck surgery. The problem began when degenerative changes in his cervical spine (neck) started putting pressure on the spinal cord. He first noticed pain in the left side of his neck and down his left arm. Then he began to lose coordination and strength in both arms.

After five years, he ended up having surgery to release pressure on the nerves. Parts of several vertebrae were removed. Those vertebrae were then fused together. Screws and a metal plate were used to hold the spine steady. Within a day of surgery, the man's condition went downhill. He needed another surgery to relieve swelling and fuse another vertebra.

The patient's condition still wasn't good after the second surgery. He lived in a rehab center and improved a bit over the next two years. But he started developing pneumonia again and again. Fluids from his esophagus were somehow getting into his lungs. Tests showed that the metal plate used to fuse the cervical spine had torn a hole in the esophagus. Doctors closed the hole in his esophagus and changed the plates and screws in his spine.

This case is unusual for several reasons. Problems with screws and plates generally show up soon after surgery, not years later. Usually when plates or screws damage nearby structures, they broke or were placed incorrectly. But in this case, the plates and screws were in their proper position. Nothing had slipped or broken. The authors recommend that doctors check the esophagus if a patient with cervical spinal fusion has problems with pneumonia.

References: Brian P. Witwer, MD, and Daniel K. Resnick, MD. Delayed Esophogeal Injury without Instrumentation Failure: Complication of Anterior Cervical Instrumentation. In Journal of Spinal Disorders & Techniques. December 2003. Vol. 16. No. 6. Pp. 519-523.

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