Implant Migration After Anterior Cervical Spine Surgery: A Systematic Literature Review

Systematic literature review.

To summarize the demographics, diagnosis, clinical course, management, and outcomes for implant migration after anterior cervical spine surgery.

Implant migration following anterior cervical spine surgery is a rare event that may predispose patients to high morbidity due to the proximity of cervical implants to critical structures. Due to the infrequency of this complication, most of the literature on this topic is described in case reports or series.

We screened the PubMed database for relevant publications from January 1975 to December 2023 using the terms: (screw OR hardware OR plate OR implant OR instrumentation) AND (pull-out OR migration OR displacement OR erosion OR perforation) AND (anterior cervical OR ACDF OR ACCF). The PRISMA systematic review template guided the identification and screening of full-text articles in English.

Fifty-five studies with 76 patients were included. The median age was 50.0 (32.0, 60.0) years, with a median time-to-diagnosis of 15 months (2.0, 60.8). Seventy-five percent were symptomatic, while 20% were asymptomatic. Common symptoms included dysphagia (54%), neck pain (22%), and fever or cervical abscess (13%). Treatments included complete implant removal (59%), partial removal (20%), spontaneous gastrointestinal elimination (11%), and retention of all instrumentation (5%). In addition, 25% underwent revision spinal fusion. Sixty-one percent experienced major complications (eg, perforation, fistula, abscess). However, 84% had resolution of symptoms without further treatment at the most recent follow-up.

Implant migration after anterior cervical spine surgery is rare yet may occur many years after a patient's initial surgery without heralding symptoms. For this reason, surgeons should consider extended routine follow-up with radiographic imaging in these patients, for the first 5 years postoperatively since this complication transpired most frequently within this time frame. We recommend an individualized, patient-centered approach for radiographic follow-up to balance the risk of unnecessary radiation exposure in addition to practical risks like travel-related accidents. Extended routine follow-up may be most beneficial for patients with identified risk factors for late complications or early migration, that is, complex deformity or poor bone quality.