Complete Migration of Metallic Plate in a Pseudodiverticulum of Cervical Esophagus

Migration of cervical hardware into the esophagus after anterior cervical discectomy and fusion (ACDF) is a rare but serious complication. Most esophageal injuries present within days of surgery, and delayed diagnosis may lead to perforation and deep-neck or mediastinal abscess. Safe, definitive treatment is only possible with implant removal to prevent mediastinitis, aspiration pneumonia, and sepsis. Herein, we present a case of an uncommon late-onset esophageal complication due to metallic plate migration 20 years after ACDF, which was managed using direct suturing and sternocleidomastoid muscle (SCM) flap reinforcement.

A 63-year-old man who had undergone ACDF 20 years previously was admitted to a local hospital with fever, dysphagia, and neck pain. Based on the CT findings, the patient was diagnosed with esophagitis secondary to a foreign body in the cervical esophageal diverticulum. An endoscopic study showed that a metallic plate for the ACDF was exposed in the posterior wall of the cervical esophageal diverticulum. The patient was then transferred to our hospital for surgical treatment. During surgery, the metallic plate was found to be completely exposed to the lumen of the diverticulum of the cervical esophagus. After opening the posterior wall of the esophagus, the metallic plate was successfully removed and the diverticulum was resected. The defect in the cervical esophagus was closed and reinforced using an SCM flap. The patient recovered uneventfully and was discharged after radiologic confirmation of unhindered passage of contrast medium and no leakage. Histological examination of the resected diverticulum wall revealed the mucosa and submucosa, but not the muscular layer.

Metallic plate migration into a pseudodiverticulum of the cervical esophagus occurring 20 years after ACDF is a rare but serious complication. The metallic plate was removed and the esophageal diverticulum was closed using direct suturing, followed by reinforcement with an SCM flap.