Anterior odontoid screw fixation extrusion as reason for oesophagus perforation

Type II odontoid fractures are mostly encountered in the elderly. Due to a high risk of non-union fractures in the case of conservative treatment, surgical fixation is widely recommended. Anterior odontoid screw fixation (AOSF) is a method that allows for a wide range of cervical mobility, and it is a relatively safe procedure that is recommended as the method of choice, although rare complications can be fatal when it leads to life-threatening oesophageal perforation.

The aim of this study is to present potential risk factors which lead to these rare complications, and possible methods of treatment.

This article presents the case of a patient hospitalised in the Neurosurgery Department of St Lukas Hosital in Tarnów in 2016. A literature review was performed using PubMed; search criteria included the phrases 'odontoid fracture perforation' and 'anterior cervical spine perforation'. The search returned 235 articles, of which 55 publications were in line with the subject of this paper, with only 12 deemed appropriate for consideration.

The authors present the case of an elderly patient with a history of odontoid fracture. Ten weeks after primary AOSF, the patient came to the Neurosurgery Department due to expectorating screws. This implied the need for further examination and even oesophageal reconstructive surgery or another spinal surgery. In laryngological examination and in gastroscopy there were no signs of fistula. In this case conservative treatment was proceeded. Due to odontoid fracture, non-union cervical posterior stabilisation was necessary.

Patients with oesophageal perforation should be treated with special care.