Delayed postoperative erosion of hypopharynx after anterior hardware extrusion: A case report

Esophageal breach or pharynx perforations are serious and potentially fatal complications of anterior cervical corpectomy/fusion (ACF). They are either recognized intraoperatively or are diagnosed within several postoperative days. Here, a 76-year-old male presented with the retropharyngeal extrusion of an anterior cervical expandable cage that occurred two years postoperatively.

A 76-year-old male with a history of an anterior corpectomy/fusion (C3-C6, corpectomy C4, C5) performed two years ago presented with persistent dysphagia for three months. Cervical X-rays showed anterior migration of the expandable cage and that was also confirmed by computed tomography (CT) scans. During intubation, the anesthesiologist observed that the cage had directly penetrated the hypopharynx. Following routine removal of the cage, ENT could not identify (using the operating microscope) any direct perforation of the esophagus or hypopharynx; presumably, the esophageal breach was small, and the esophageal wall spontaneously closed the gap following cage excision.

Pharyngeal perforation after ACF is typically associated with significant morbidity and mortality. Stringent preoperative assessment, utilizing X-rays, magnetic resonance/CT studies, and ENT specialists to perform indirect laryngoscopy, may optimize postoperative outcomes.